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February 20, 2020

Image challenge: Think twice before extracting a harmless foreign body

What caused what looked like a bumper to form in the upper esophagus of a patient that had previously been treated due to similar findings?
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Gastroenterology clinical image challenge: An 86-year-old man with a past medical history of squamous cell carcinoma of the larynx and total laryngectomy with tracheostomy presented for evaluation of severe iron deficiency anemia (hemoglobin of 6.4 g/dL). He had no upper gastrointestinal symptoms and underwent upper endoscopy. Upon slowly endoscopic withdrawal, a foreign body in the upper esophagus was visualized. This looked like the bumper from a conventional percutaneous endoscopic gastrostomy (figure).

Careful investigation of the patients’ medical records revealed that two years ago, in March 2017, owing to odynophagia, he also underwent a gastroscopy with similar findings. Moreover, he underwent a video-swallow study that demonstrated a normal swallowing mechanism without evidence of pooling of contrast or aspiration. In November 2018, the patient had a cervical and chest computed tomography san with no metastasis.

Correlating these clinical, endoscopic and radiological findings with the patient’s history and background what is the diagnosis of the esophageal foreign body?

To find out the diagnosis, read the full case in Gastroenterology.

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