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Endoscopy 2015; 47(S 01): E406-E407
DOI: 10.1055/s-0034-1392615
Cases and Techniques Library (CTL)
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic extraction of a fish bone with a Foley catheter after endovascular stent graft placement for penetrating aortoesophageal injury

Xiangjiu Ding
1   Department of Vascular Surgery, Qilu Hospital, Shandong University, Jinan, China
,
Qingbo Su
1   Department of Vascular Surgery, Qilu Hospital, Shandong University, Jinan, China
,
Ning Zhong
2   Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
,
Jianjun Jiang
1   Department of Vascular Surgery, Qilu Hospital, Shandong University, Jinan, China
› Author Affiliations
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Publication Date:
14 August 2015 (online)

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A 55-year-old man was admitted with retrosternal pain and odynophagia of 5 days’ duration. The patient had ingested a fish bone just before the onset of symptoms. He had a 4-year history of coronary artery disease and myocardial infarction. Computed tomography showed a foreign body penetrating through the esophagus into the thoracic aorta ( [Fig.1]). No signs of mediastinitis were identified.

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Fig. 1 Computed tomographic scan showing a foreign body penetrating through the esophagus into the thoracic aorta in a 55-year-old man presenting with retrosternal pain and odynophagia.

After a multidisciplinary discussion, endoscopic bone removal was planned with simultaneous endovascular stent graft placement. A 34 × 180-mm stent graft was implanted in the thoracic aorta via the femoral artery ([Fig. 2 a]). Gastrointestinal endoscopy revealed a fish bone lodged in the esophagus at 250 mm from the incisors. Both ends were impacted in the esophagus, with a short segment in the lumen ([Fig. 2 b]). Despite numerous attempts at removal with a foreign body forceps, neither end could be separated from the esophageal wall because of the narrow space. It was impossible to cut the hard bone endoscopically.

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Fig. 2 a Intraoperative aortography showing no extravasation of contrast agent after stent graft placement. b Both ends of the bone are impacted in the esophagus close to the second narrowing. c The catheter balloon dilating the esophageal lumen. d A 40-mm-long sharp bone with two pointed ends.

As a last attempt before surgery, a 14 Fr Foley catheter was introduced beyond the bone. The catheter was inflated with 15 mL of normal saline, dilating the portion of the esophageal lumen distal to the bone ([Fig. 2 c]). The bone, which was almost 40 mm long with two pointed ends ([Fig. 2 d]), was then separated and extracted. A nasojejunal feeding tube was placed. The patient’s postoperative recovery was uneventful ([Fig. 3]).

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Fig. 3 Computed tomographic scan before nasojejunal tube removal showing no paraesophageal collection or mediastinitis.

Several instruments have been used to retrieve foreign bodies, including forceps, polypectomy snare, and Roth basket. A major disadvantage of these tools is their limited ability to overcome anatomical obstacles [1]. A Foley catheter is usually used under fluoroscopic guidance to remove blunt foreign bodies from children [2]. In our case, we used this simple and primitive type of catheter to dilate the esophagus before bone removal. The use of a Foley catheter is an option for extracting sharp objects with two ends impacted in the esophagus.

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  • References

  • 1 Munoz JC, Habashi S, Corregidor AM et al. Extraction of hollow gastric foreign bodies by flexible upper endoscopy assisted by a through-the-scope balloon catheter for anchoring. Gastrointest Endosc 2008; 67: 519-521
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