Stuck in the Middle! A Case of Repeated Foreign Body Impaction in Oesophagus CD01-CD03
Y Radha Krishna,
GIMSR, Visakhapatnam, Andhra Pradesh, India.
Oesophageal foreign body impaction is usually seen in children as well as in adults with varying aetiologies. It is an emergencysituation requiring proper evaluation and prompt treatment because of the possible complications like oesophageal perforation,mediastinitis and aspiration. Here, the report presented an interesting case of repeated foreign body impaction in the loweroesophagus of an elderly male. A 76-year-old male patient came to the Emergency Department in a Tertiary Care Center withchest pain and obstruction in the passage of food which had begun several hours prior to visit after having a chicken meal. Thepatient had presented with similar complaints in the past on three different occasions. The clinical examination was normal. Asa part of the treatment, urgent upper gastrointestinal endoscopy was performed by using olympus flexible video endoscopeunder general anaesthesia, which showed meal impaction in distal oesophagus. The impaction was removed successfully withcombination of rat tooth forceps and endoscopic snare. Later on after successful retrieval during his subsequent visit in view of hisrepeated foreign body impaction, further evaluations including High-Resolution Manometry (HRM) were performed which revealedmultiple oesophageal spasms during the passage of food, with premature peristalasis and thereby, it was diagnosed as DiffuseOesophageal Spasm (DES). The patient was given nitrates and kept on calcium channel blockers for long term medication. DES isan uncommon cause of dysphagia, for which oesophageal manometry is the gold standard procedure. Presence of synchronouscontractions in a minimum of twenty for one hundredth of wet swallows (constituting 20%), alternating with normal motility patternsis a diagnostic criteria for DES on manometry. HRM has been a significant improvement in the accuracy of describing the variousmotility disorders of oesophagus.