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Introduction
Foreign body ingestion is common among pediatric and adult populations, more frequent in the former, and foreign bodies can further be categorized as food and nonfood. Nonfood foreign body ingestion, a true foreign body ingestion, is more commonly seen in incarcerated adults and adults with psychiatric comorbidities [1]. The ingestion of foreign bodies continues to be a frequent reason for consultation and, in some circumstances, is still considered an emergency in gastroenterology. Esophagogastroduodenoscopy (EGD) is the method of choice as it is diagnostic and therapeutic [2].
Case presentation
An 18-year-old male patient from Addis Ababa, Ethiopia working as a tailor presented with pain and being unable to swallow solid food of five days duration after he had accidentally swallowed a sewing needle while working. His relatives later tried to remove the needle using another small flat metal which later on slipped and stacked in his throat. He had no abdominal pain, swelling or vomiting. He had no cough, chest pain or shortness of breath. On physical examination he appeared quite stable with a blood pressure(BP) of 110/70mmHg, pulse rate-92 per minute, SaO2- 96% at room temperature, respiratory rate- 20 breaths per minute, and axillary temperature = 36.9ºC. His chest was clear and resonant. There was soft, non-tender abdomen to gentle palpation. Bowel sounds were normoactive.
Laboratory evaluation showed a normal complete blood count (CBC) and serum creatinine level. Erect chest x ray (CXR) and plain abdominal film were done immediately as shown below (Figs. 1 and 2).
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Fig. 1
Radiopaque shadow at the prevertebral soft tissue at the level of the thoracic inlet (blue arrow) showing esophageal metallic foreign body at 5th day post ingestion
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Fig. 2
Plain abdominal radiograph showing a linear radiopaque shadow (sewing needle) at the left paravertebral region on 5th post ingestion day
The patient was sedated after the anesthesia team was called into action. Titrated doses of intravenous propofol and fentanyl were used. Cardiothoracic surgery team was alerted in case complications would happen. Later endoscopy was done at the endoscopy unit showing a flat, rectangular sharp metallic object...