Small Plastic Objects Can Cause Foreign Body Impaction in Normal Adult Esophagus: 3098

INTRODUCTION: Foreign body impaction in the esophagus results from an inability of a swallowed object to pass through the esophagus to the stomach. In the United States, food, especially boneless meat, is the most commonly impacted foreign body. When impaction of a foreign body occurs in an adult esophagus, it usually occurs in the presence of underlying structural abnormalities (such as a web or stricture), functional abnormalities resulting from abnormal esophageal peristalsis, or when the swallowed object is too large to navigate the anatomic constrictions of the normal esophagus. This report describes two patients who had retained plastic foreign bodies in the esophagus in the presence of a normal esophageal anatomy. CASE DESCRIPTION/METHODS: Patient 1: A 39 year old man came to emergency room after accidentally swallowing a 2 cm plastic ring. He was able to swallow fluids and oral secretions, but felt a foreign body sensation in his upper chest. He denied any prior dysphagia. On endoscopy, a white plastic ring was seen in the mid-esophagus with no associated esophageal injury. Esophagus was normal with shiny mucosa. With insufflation and gentle prodding with the endoscope, the plastic ring easily passed into the stomach where it was captured using an endoscopic net and retrieved. The patient was discharged home after the procedure. Patient 2: A 53 year old woman presented to the emergency room with history of foreign body sensation and odynophagia localized to mid-chest after drinking an open cup of water. She was able to swallow water and oral secretions, but felt a sharp pain in the mid-chest every time she did so. Although she had seen a foreign body, she was convinced that she had foreign body stuck in her esophagus. Endoscopy showed a thin square piece of plastic measuring about 1 cm in size retained in a normal appearing esophagus with no obvious esophageal injury. It was retrieved using an endoscopic net. She was discharged home after the procedure. DISCUSSION: This report demonstrates that foreign bodies made of plastic can be retained in the adult esophagus in the absence of traditional risk factors. They can also present with atypical clinical features. The composition of plastic may make it more adherent to the esophageal mucosa thus preventing easy transit through the esophagus, even in the absence of restrictions in the esophagus. This report demonstrates the importance of endoscopic evaluation when a foreign body is suspected, even in the absence of a traditional presentation.