Foreign body (FB) ingestions are a common problem in gastroenterology clinical practice and are one of the reasons for urgent endoscopy. Particularly, emergency or urgent endoscopy should be performed in patients with suspected esophageal FB ingestion, because serious complications can develop. We report a very rare case of drooling and dysphagia caused by a plastic bag.
Case Report
A 28-year-old man presented to the emergency department, with drooling and dysphagia that developed immediately after swallowing a plastic black bag. He had a history of schizophrenia. Physical examination was unremarkable. Emergency endoscopy was performed and showed the impacted black plastic bag piece and grass in the middle third of the esophagus (Figure 1). This was removed with a snare (Figure 2). The removed plastic bag was knotted and there was grass in the black plastic bag.
Discussion
Most FB ingestion cases occur in children or those with a psychiatric disorder or intellectual disability (Eisen et al., 2002). These patients may not always provide an appropriate medical history. Because of the inability to obtain adequate medical information in patients with intellectual disability or psychiatric disorders, the presence of an FB is only suspected (Sugawa, Ono, Taleb, & Lucas, 2014).
Most foreign bodies (80%-90%) pass spontaneously. It is considered that 10%-20% require endoscopic intervention. In the great majority of cases, endoscopy solves the problem and in only less than 1% of the cases is surgery required.
Foreign bodies can become impacted in the esophagus at the three physiological levels of narrowing: the cricopharyngeal sphincter, aortic arch, and diaphragmatic hiatus (Eisen et al., 2002; Sugawa et al., 2014). A foreign object or food bolus ingestion should never be allowed to remain in the esophagus for 24 hours or more (Sugawa et al., 2014). Unless they are removed at the appropriate time, the risk of complications increases, including risk of perforation (Ikenberry et al., 2011).
Summary
Recent American Society of Gastrointestinal Endoscopy (ASGE) guidelines state that emergency endoscopy should be required for patients with symptoms due to total obstruction of the esophagus, disk batteries, and sharp-pointed objects in the esophagus. Urgent endoscopy should be required for the extraction of all esophageal foreign bodies, regardless of the type. But endoscopy should be performed whenever possible in patients who are mentally incompetent (Ikenberry et al., 2011).
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