A New Method for Extracting Wooden Foreign Bodies from the Upper Esophagus

• Introduction
• Case Report
• Results
• Discussion
• References

A foreign body impacted in the esophagus is an emergency case that requires immediate treatment. Often the foreign body can be removed easily using forceps or loops. Sometimes, however, safe grasping and extraction may become very difficult.

A patient swallowed a chestnut which then stuck in the upper esophagus. The chestnut was removed with a gynecological instrument with a spiral tip used for myoma fixation. Thereafter this technique was applied to in vitro tests with various kinds of meat and wood.

In the clinical case, the chestnut could be removed with the spiral tip of the instrument for myoma fixation, whereas in the in vitro tests it was impossible to grasp meat or cut it into pieces.

The removal of foreign bodies, such as wood, with the spiral tip of the instrument for myoma fixation during rigid esophagoscopy is an alternative to extraction with forceps or loops. This method is ineffective for the removal of pieces of meat.

Introduction

In endoscopic practice, swallowed foreign bodies are often found in the upper gastrointestinal tract, to a similar degree in the stomach and in the esophagus [1]. In about 43 % of all cases foreign bodies stick in the esophagus; in adults 55 - 57 % of them are pieces of meat (steakhouse syndrome) [1] [2] . Pathologic changes of the esophagus may lead to passage obstruction in 70 % of these patients. To avoid the formation of necroses followed by perforation and mediastinitis, the incarcerated foreign bodies must in any case be removed from the esophagus [1] [3] .

Various methods of removing foreign bodies from the upper gastrointestinal tract have been described. The objective is to extract the foreign body in one piece without damage to the gastrointestinal wall. Occasionally it may be necessary to reduce the foreign body to small pieces before extraction. Another method is to push the foreign body into the stomach, to extract it from there or to wait for natural passage [1] [3] . Since the establishment of endoscopic methods, foreign bodies have required extraction by open surgical intervention in only 0.5 % of all cases [2] [4] .

When foreign bodies have become incarcerated in the cervical esophagus, rigid esophagoscopy under general anesthesia offers some advantages [1].

For the removal and cutting into small pieces of foreign bodies, forceps of various shapes as used in endoscopy, minimally invasive surgery, and ear, nose, and throat procedures [1] [3] are used, or laser-assisted removal is performed [5]. Loops, normally used to resect intestinal polyps, or the Dormia basket may also be used to retrieve foreign bodies in toto [1] [3] .

A new and simple method for the removal of wooden foreign bodies from the cervical esophagus is described below.

Case Report

A large chestnut had become incarcerated in the upper third of the patient's esophagus below the larynx and could not be moved by external manipulation. Flexible and rigid endoscopy showed that it was fixed in the esophagus, which was edematous, and a loop extraction had become impossible. Due to its consistency and size the chestnut could not be removed in one piece. The attempt to reduce it into small pieces by means of various forceps was quite laborious. Therefore, an instrument usually applied in gynecology for the fixation of myomas was used. With the spiral tip of the instrument, which functions in the same way as a corkscrew, we were able to drill into the chestnut and gently extract the whole body (Figure [1]).

Thereafter we tested this instrument on other organic materials. In several in vitro tests, various kinds of meat and wooden material (Table [1]) that might cause similar problems as the chestnut (steakhouse syndrome) [1] were stuck with resistance into flexible silicon tubes. The gynecological instrument was drilled into the material, which we then tried to extract by pulling.

Results

In the clinical case the chestnut could be safely extracted with the spiral-tipped instrument for myoma fixation. The instrument did not cause any lesions on the esophageal wall.

In the in vitro tests the gynecological instrument did not retain the different pieces of meat. It made no difference how well the meat was cooked or what kind of meat was used. The spiral tip could not grasp the fibrous tissues and a reduction into small pieces could not be achieved, as the tip tore out of the meat. The spiral tip could not be drilled into pieces of hard wood either.

In contrast, chestnuts and acorns were easily fixated and pulled out of the tube (Table [1]).

Discussion

The appropriate method for extraction of foreign bodies from the esophagus is determined by the size, the texture of the surface, and the material of the incarcerated foreign body. For wooden foreign bodies the “corkscrew” method with the instrument for myoma fixation may be used. To avoid lesions, it is important that the spiral tip does not break through the foreign body into the tissue. A final endoscopic examination of the esophagus for lesions and further foreign bodies should always be performed. For pieces of meat the myoma-fixation instrument is ineffective.

References

• 1 Porse G, Mickisch O, Manegold B C. Endoskopische Fremdkörperextraktion. In: Fuchs KH, Hamelmann H, Manegold BC (eds). Chirurgische Endoskopie im Abdomen.  Berlin; Blackwell, 1992: 82-92
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• 2 Guitron A, Adalid R, Huerta F, et al. Extraction of foreign bodies in the esophagus. Experience in 215 cases.  Rev Gastroenterol Mex. 1996;  61 (1) 19-26
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• 3 Rückauer K, Waldmann D. Probleme der endoskopischen Fremdkörperextraktion. In: Richter H (ed). Chirurgische Endoskopie - Komplikationen bei Diagnostik und Therapie.  Munich; Urban and Schwarzenberg, 1985: 58-60
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• 4 Stewart K C, Urschel J D, Fischer J D, et al. Esophagotomy for incarcerated esophageal foreign bodies.  Am Surg. 1995;  61 (3) 252-253
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• 5 Weber F X, Deplaix P, Barthelemy C, et al. Laser assisted removal of a foreign body from the esophagus.  Endoscopy. 1996;  28 (5) 464
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U. Matern,M.D. 

Study Group Surgical Technologies Dept. of General Surgery University Hospital of Freiburg

Hugstetter Strasse 55 79106 Freiburg

Germany

Fax: Fax:+ 49-761-270-2601

Email: E-mail:matern@ch11.ukl.uni-freiburg.de

References

• 1 Porse G, Mickisch O, Manegold B C. Endoskopische Fremdkörperextraktion. In: Fuchs KH, Hamelmann H, Manegold BC (eds). Chirurgische Endoskopie im Abdomen.  Berlin; Blackwell, 1992: 82-92
  Search in Google Scholar
• 2 Guitron A, Adalid R, Huerta F, et al. Extraction of foreign bodies in the esophagus. Experience in 215 cases.  Rev Gastroenterol Mex. 1996;  61 (1) 19-26
  PubMedSearch in Google Scholar
• 3 Rückauer K, Waldmann D. Probleme der endoskopischen Fremdkörperextraktion. In: Richter H (ed). Chirurgische Endoskopie - Komplikationen bei Diagnostik und Therapie.  Munich; Urban and Schwarzenberg, 1985: 58-60
  Search in Google Scholar
• 4 Stewart K C, Urschel J D, Fischer J D, et al. Esophagotomy for incarcerated esophageal foreign bodies.  Am Surg. 1995;  61 (3) 252-253
  PubMedSearch in Google Scholar
• 5 Weber F X, Deplaix P, Barthelemy C, et al. Laser assisted removal of a foreign body from the esophagus.  Endoscopy. 1996;  28 (5) 464
  PubMedSearch in Google Scholar

U. Matern,M.D. 

Study Group Surgical Technologies Dept. of General Surgery University Hospital of Freiburg

Hugstetter Strasse 55 79106 Freiburg

Germany

Fax: Fax:+ 49-761-270-2601

Email: E-mail:matern@ch11.ukl.uni-freiburg.de