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Significance of the Study
• The clam shell was retrieved by performing cervical esophagotomy and the patient recovered well. Clinicians should be aware of this particular type of foreign body ingestion because it necessitates prompt surgery rather than nonoperative management or endoscopy.
Introduction
The ingestion of a foreign body with impaction in the esophagus is a common gastrointestinal emergency [1,2]. A myriad of usual as well as infrequent objects have been reported [1,2]. Clam shell ingestion represents a very unusual occurrence; as of 2017, only 6 cases have been described in the literature. Differently from other materials, the retrieval of this bivalve mollusk can entail very serious medical and surgical problems. We report the successful removal of a clam shell by cervical esophagotomy.
Case Report
A 77-year-old man presented with acute dysphagia after eating a seafood risotto. His previous medical history was significant for cervical spine fixation performed 24 years previously because of amyotrophic lateral sclerosis. At the visit, apart from the oropharyngeal discomfort, the patient was eupneic and hemodynamically stable. A noncontrast helical multislice computed tomography (CT) scan of the neck was performed urgently: a radio-opaque foreign body with a concave morphology and a diameter of 4 cm was seen lodged in the upper esophagus at the subglottis level anteriorly to C6-C8 (Fig. 1a). Imaging sagittal reconstruction outlined a maritime design congruent with the shell of a clam (Fig. 1b). An immediate flexible endoscopy was performed that confirmed a whitish clam shell as the foreign body (Fig. 2); however, it failed to retrieve the object due to its particularly milled surface. Three flexible esophagoscopies were attempted subsequently but were all unsuccessful. Thereafter, a rigid endoscopy was carried out but the removal maneuvers...