S2124 Will You Be My Valentine?

Introduction: Accidental ingestion of foreign objects is common in children. In adults, it is a rare event which usually occurs in older adults with psychiatric conditions, acute intoxication or cognitive impairment. Ingested foreign bodies can lodge at anatomical areas in the esophagus where the lumen is reduced, such as the upper and lower sphincters or at the level at the aortic arch. Correct identification and classification of the object allows for proper timing and planning for safe and effective object retrieval. Case Description/Methods: This is the case of an 87-year-old man with advanced dementia who was brought to the emergency room due to left-sided weakness and slurred speech. He was not coughing, drooling, nor complaining of throat or chest discomfort. Head CT confirmed the diagnosis of an acute ischemic stroke. The gastroenterology service was consulted due to an incidental finding on routine chest X-ray that was confirmed with a chest-CT (Figures 1A-B). An upper endoscopy was performed and the esophageal foreign object was successfully removed (Figures 1C-D). The patient tolerated the procedure well and was eventually discharged home. The patient’s wife was happy to be reunited with her husband along with the wedding ring which had been “missing” for several days. Discussion: This case illustrates an asymptomatic case of accidental ingestion of a foreign object that was successfully treated resulting in the recommitment of wedding vows of this loving couple. It is important to always “think out of the box” when managing patients with advanced dementia. Careful review of this patient’s imaging study caused a drastic change in management which resulted in a significant benefit for the patient.Figure 1.: A- Endoscopic image of a 2cm lesion with central depression(Paris Classification 0-IIc) in the lower thoracic esophagus. B- Endoscopic ultrasound showing invasion into muscularis mucosa, no submucosal invasion and no pathological lymphadenopathy.