Unusual Esophageal Foreign Body: A Table Fork

The presence of an esophageal foreign body (EFB) is a medical emergency requiring urgent evaluation and treatment. Swallowing of foreign bodies is most common in children aged between 6 months and 6 years, in whom it usually occurs during games. In adults, foreign bodies tend to be ingested accidentally together with food. The authors report an unusual case of EFB (a table fork) in an adult and briefly report the clinical presentation and the therapeutic procedures adopted in this case and similar cases. 1. Introduction The presence of an esophageal foreign body (EFB) is a frequent reason for emergency room visits. Patients complain of dysphagia, hypersalivation, regurgitation, odynophagia, neck pain, and retrosternal discomfort. A detailed anamnesis together with anteroposterior and lateral chest X-rays normally allows a rapid diagnosis. In most cases, EFBs are found to be impacted in the upper part of the esophagus at the level of the first anatomical constriction. The type of EFB differs depending on the age and eating habits of the subject. Thus, EFBs found in children are often coins, safety pins, toy parts, and small batteries [1], whereas in adults they are more likely to be boluses of food, meat bones or meat bone fragments, fish bones, parts of dentures, toothpicks, and nails or screws [2, 3]. In childhood, foreign bodies are usually ingested accidentally during games. In adulthood, the involuntary ingestion of foreign bodies is almost always correlated with the presence of predisposing factors, such as dentures, decreased sensitivity of the oropharyngeal mucosa, and neurological diseases. The presence of certain preexisting pathological conditions (e.g., strictures, diverticula, malignancy, and achalasia) can facilitate EFB impaction. 2. Clinical Case A 62-year-old Caucasian male entered the emergency room complaining of dysphagia, hypersalivation, and dyspnea. He was evidently drunk. He reported that he had been touching the roof of his mouth with the handle of a table fork in an attempt to stop persistent hiccups and in so doing had accidentally swallowed the fork. Antero-posterior and lateral chest X-rays showed the fork in the esophagus (Figure 1). A fiber-optic endoscopic examination was performed and showed the prongs of the fork projecting from the upper esophageal sphincter in the retroarytenoid area. Figure 1: Antero-posterior and lateral X-rays of the thorax showing the foreign body (a table fork) occupying the entire thoracic esophagus. The patient underwent general anesthesia during which the 22？cm long fork was removed under