Asian Cardiovasc Thorac Ann 2005;13:70-71
© 2005 Asia Publishing EXchange Ltd
An Unusual Foreign Body of The Esophagus
ER Metin, MD
Department of Thoracic Surgery, Yuzuncu Yil University, Medical School, Van, Turkey
For reprint information contact: ER Metin, MD Tel: 90 432 214 2457 Fax: 90 432 216 7519 Email: mer{at}yyu.edu.tr, Yuzuncu Yil Universitesi Tip Fakultesi, Gogus Cerrahisi AD, Van 65200, Turkey.
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ABSTRACT
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Foreign bodies in the esophagus can result in serious complications depending on the size and shape of the ingested body. This report presents an unusual esophageal foreign body (endotracheal tube) caused by a physican who was inexperienced in endotracheal intubation during the treatment of generalized convulsive status epilepticus.When the patient was transferred to our hospital, rigid esophagoscopy was used to extract the endotracheal tube. There were no complications.
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INTRODUCTION
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Severe complications such as perforation of the esophagus, mediastinitis or foreign body ingestion frequently require emergency esophagoscopy. An endotracheal tube is a very rare and unusual foreign body in the esophagus. Since esophageal perforation is a life threatening condition, the correct placement of an endotracheal tube is important and requires skill. Surgery is rarely required. Round the clock endoscopy should be available at acute care hospitals in the same way as other emergency facilities.
I present an unusual esophageal foreign body, more precisely an esophago-gastric body, in this case, an endotracheal tube was put in during endotracheal intubation in a rural hospital. When the patient was transferred to our hospital, the tube was successfully removed by endoscopy.
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CASE REPORT
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A 27-year-old man was admitted to the Emergency Room (ER) of our hospital. He was in generalized convulsive status epilepticus at the time of arrival. His medical history showed that he had been diagnosed with epilepsy 3 years ago. He had been advised to take epilepsy drugs on a continuous and routine basis in a controlled environment at the hospital. Due to his low socioeconomic and cultural status, he had stopped taking the drugs for the past year and a half. Following a sudden epileptic seizure, he was transferred to a rural hospital and was given anticonvulsant agents. But his generalized convulsive status epilepticus could not be treated by the physician, in order to open the airway the physician tried endotracheal intubation. The patient, accompanied by a nurse was then transferred to our hospital by an ambulance. After an hour of traveling, the patient was admitted to our ER, and treatment was given for his generalized convulsive status epilepticus. After two hours of medication, his status epileptic subsided. After the patient recovered, his relatives mentioned the insertion of a tube into his mouth while he was at the rural hospital, but there was no endotreacheal tube in the patient’s mouth. The nurse from the rural hospital confirmed that the patient’s esophagus was intubated instead of the trachea by accident. Dislodgement of the endotracheal tube was impossible during transfer by ambulance.
The ER physicans immediately took a postero-anterior chest X-Ray, an endotracheal tube was visible beginning at the esophagus and ending at the stomach (Figure 1
). The patient was then immediately taken to the operating room. Under general anesthesia, a 9.5 mm internal diameter and 13 mm external diameter endotracheal silicon tube was successfully removed using rigid esophagoscopy. It was interesting to note that there was no connector for the endotracheal tube. There were no complications and the patient was transferred to the neurology department after being observed for 24 hours.
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Figure 1. Postero-anterior chest X-Ray of the patient showing an unsual foreign body in the esophagus (an endotracheal tube). (White arrow: Upper tip of the endotracheal tube beginning below the first narrowing of the esophagus. Black arrow: End of the endotracheal tube in the corpus of the stomach).
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DISCUSSION
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This kind of foreign body in the esophagus is an unusual case. Ingestion of foreign bodies is common especially among children, whereas in adults it occurs more commonly among those with psychiatric disorders, or mental retardation, prisoners and alcoholics.1 Fortunately, most of them pass through the gastrointestinal tract harmlessly. However, 10% to 20% will require nonoperative intervention and only 1% or less requires surgery.2 The most common types of ingested objects in the esophagus are food related foreign bodies, such as bones, meat bolus, nuts, seeds or shells, coins, artificial dentures, pins and toys.3 Morbidity rates reported in the literature are lower than 1%.1 Endoscopy is the most preferred method of extraction of an esophageal foreign body (EFB).3 Surgery is inevitably considered when perforation or aortoesophageal fistula is present, or when the extraction is considered either dangerous or impossible by the endoscopist. Besides an anamnesis and a physical examination, radiology is a very important diagnostic tool for identifying the EFB and its location.
In the literature some authors reported unusual EFBs, Cangir and colleagues reported a fork,4 Basha and collegaues reported a Groningen speaking valve,5 a mouse entrapped in the adult esophagus was reported by Ren PL.6 There are several reports of a titanium mesh stent for carcinoma of the esophagus as an unusual EFB. Although a few swallowed endotracheal tubes in neonates are reported in the literature, Sing and colleagues reported a swallowed endotracheal tube in an adult who had a closed head injury and was intubated by a paramedic on the scene.7 Accidental esophageal intubation (even by anaesthetists) in operating rooms is still a major cause of anaesthetic morbidity and mortality.8
I emphasize that all physicans must be experienced in endotracheal intubation, especially those working in rural hospitals where there are no anesthetists. Physicians who are inexperienced should not try endotracheal intubation.
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REFERENCES
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- Basha SI, Durham LH. An unusual case of dysphagia: retained Groningen valve. J Laryngol Otol
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- Ren PL. A rare foreign body: a mouse entrapped in the adult esophagus. Endoscopy
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- Sing RF, Huynh TT, Gibbs MA, Perron AD. The "Swallowed’’ endotracheal tube. Am J Emerg Med
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- Mehta KH, Turley A, Peyrasse P, Janes J, Hall JE. An assessment of the ability of impedance respirometry distinguish oesohageal from tracheal intubation. Anaesthesia November
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ABSTRACT
INTRODUCTION
