A 21-Year-Old Man With Epigastric Pain After a Wild Party

Abraham A. Ayantunde, MB BS, FRCS; George G. Araklitis, MB BS, BSc

Disclosures

February 25, 2019

To summarize, any esophageal foreign-body obstruction should be treated endoscopically within 24 hours. Disc batteries pose the highest risk for caustic injury and perforation. Luminal abnormalities must be excluded at the site of obstruction, usually through follow-up endoscopy. More variation is observed in practice with respect to the management of a foreign body that has reached the stomach. Some centers take a liberal wait-and-watch approach for passage of even large (0.8-2 in [2-5 cm] oval or 2.4-3.9 in [6-10 cm] long) and sharp objects. Most endoscopists, however, attempt removal of foreign-body obstructions larger than 0.8 in (2 cm) in circular diameter and/or more than 2.4 in (6 cm) long, as these are deemed unlikely to pass the pyloric channel and duodenal sweep, respectively.

Sharp objects that remain in the stomach still carry a small but significant risk for complication if left untreated, and regulatory bodies generally recommend that they be removed endoscopically if possible.[8]

The patient in this case was observed for 12 hours. His symptoms did not resolve and he continued to have epigastric and chest pain. Repeat x-rays of the chest and abdomen revealed that the foreign body had not moved from the gastroesophageal junction. An emergency esophagogastroduodenoscopy was performed to retrieve the bottle cap within 24 hours of the patient presenting to the ED. The metallic bottle cap was visualized at the gastroesophageal junction, and it was pushed down into the gastric cardia before retrieval. No other endoscopic abnormality of the upper gastrointestinal tract was noted apart from associated gastritis.

Initial attempts at retrieval of the bottle cap with the large biopsy forceps failed because the cap dropped back into the stomach upon reaching into the gastroesophageal junction. It was successfully removed with a basket net. The patient was later discharged from the hospital and warned about the dangers of uncapping bottles with his teeth.

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