An elderly woman was cutting some meat and potatoes at home when she thinks the tip of her knife broke off. She didn’t realize it until she picked up a piece of potato and ate it, felt something in her throat, and then realized her knife looked like this:
She had no pain, dysphagia, drooling, shortness of breath, or other complaints.
KUB was done and shown below:
The patient was initially seen by another provider. Thinking that the tip had already passed through the esophagus and was now in the stomach, they called GI to see if anything could be done. One hour later there was no callback and the patient was eager to leave, so she was discharged. Almost immediately after she left, the on-call GI returned his page, looked at the x-ray, and asked the ER to call the patient back so that he could retrieve the item. The patient underwent endoscopic removal and was discharged home.
Learning points:
Indications for emergent endoscopic removal of foreign bodies:
| Sharp-pointed objects |
| Needle, toothpick, bone, safety-pin, partial denture, razor blade, medication blister packs |
| Object inducing esophageal obstruction |
| Food bolus |
| Object including poisons |
| Button battery |
Even objects that have passed into the stomach can be removed
No foreign body should be allowed to remain in the esophagus for more than 24 hours
