Buried Foreign Body in the Esophagus - Unusual Cause of Dysphagia in a 2-Year-Old Child

Case Report

Case history

An otherwise healthy 2-year-old boy was referred to the ORL clinic outpatient department of the University Medical Center Ulm due to progressive dysphagia and weight loss, but without respiratory symptoms. The parents reported on limited solid food intake already at the end of his first-year of life. Subsequently, he regurgitated undigested food in the course, and his diet was limited to liquid food.

Clinical examination

Otolaryngoskopic examination

The otorhinolaryngoskopic (ORL) examination did not show any abnormalities that could confirm a suspected oropharyngeal disorder. A swallowing trial with yoghurt was successful.

Pediatric examination

The child presented in good condition, measured 86 cm (P10) and weighted 11 kg (P10) with a BMI of 14.9 kg/m² (P20). Clinical examination of skin, ENT, heart, lung, abdomen, lymph nodes and neurological development was normal. The placement of a naso-gastric feeding tube failed as it was not possible to push the tube forward.

Diagnostics

Examination of the esophageal transit

Timed swallowing esophagogram in upright position using soluble iodinated contrast media (Peritrast^®) revealed a narrowing of the esophagus in its intermediate third suspicious of a vascular compression ([Fig. 1a,b]).

Fig. 1 Timed swallowing esophagogram in upright position using soluble iodinated contrast media (Peritrast^®) revealed a narrowing of the esophagus in its upper third.

Echocardiography

No aberrant right subclavian arteria (known as arteria lusoria) was detected by echocardiography as case of a retro-esophageal compression.

Laboratory values

Differential hemogram revealed twice as much eosinophil granulocytes and otherwise laboratory values within normal limits.

Endoscopy

Upper gastrointestinal endoscopy with a super-slim videogastroscope (GIF-XP 190 N, Olympus, Germany) revealed a stenosis in the proximal esophagus ([Fig. 2a]). A buried foreign body was almost covered by esophageal hyper granulated tissue. The stenosis could be passed by the endoscope and the remaining esophagus appeared completely normal without signs of eosinophilic esophagitis or other inflammation. At closer inspection a beige plastic stick protruding from the hyper granulated mucosa was found ([Fig. 2b]). Unfortunately, the attempt to remove the stick by a rat tooth forceps failed. Finally, a plastic screw cover cap of about 2 cm in diameter, which was embedded in abundant hyper-granulated esophageal tissue could be peeled off with blunt force. Thereafter, the object was placed in the stomach and removed with polypectomy-snare ([Fig. 2c, d]). A naso-gastric feeding tube was introduced under endoscopic view.

Fig. 2 Endoscopic pictures of the EGD with the excision of the screw cover cap. a Stenosis in the proximal esophagus with hyper granulated mucosal tissue. b A beige plastic stick protruding c Exposed and displaced foreign body in the stomach. d Plastic screw cover cap with 2 cm diameter. e Follow-up endoscopy after 3 months with healed mucosa.