Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2019; 7(10): 1230-1233
Published online May 26, 2019. doi: 10.12998/wjcc.v7.i10.1230
Successful endoscopic extraction of a proximal esophageal foreign body following accurate localization using endoscopic ultrasound: A case report
Xiao-Ming Wang, Shan Yu, Xin Chen
Xiao-Ming Wang, Shan Yu, Xin Chen, Department of Gastroenterology, Panzhihua Central Hospital, Panzhihua 617067, Sichuan Province, China
Author contributions: Wang XM designed the research; Wang XM, Yu S, and Chen X performed the research; Wang XM and Yu S wrote the paper.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xiao-Ming Wang, Chief Doctor, Department of Gastroenterology, Panzhihua Central Hospital, No. 34, Yikang Street, Panzhihua 617067, Sichuan Province, China. 18096308792@163.com
Telephone: +86-812-2238131 Fax: +86-812-2222606
Received: January 29, 2019
Peer-review started: January 29, 2019
First decision: February 21, 2019
Revised: March 14, 2019
Accepted: May 10, 2019
Article in press: May 11, 2019
Published online: May 26, 2019
Processing time: 117 Days and 20 Hours
Abstract
BACKGROUND

It is rare to find fish bones completely embedded in the wall of the esophagus with endoscopic findings similar to those of submucosal tumors. Most of the patients had the foreign body removed by thoracotomy or thoracoscopy in the past, which resulted in great trauma.

CASE SUMMARY

We report a 58-year-old woman who experienced dysphagia for 6 d after eating fish. Cervical computed tomography (CT) and endoscopic ultrasonography (EUS) indicated a fish bone completely embedded in the wall of the esophagus with endoscopic findings similar to those of submucosal tumors. The results of CT reconstruction and EUS suggested that the fish bone was parallel to the longitudinal axis of the esophagus. We performed a longitudinal mucosal incision from the highest point of the uplift by using an Olympus dual knife to find the fish bone. Unfortunately, no fish bone was found, so we extended the incision and endoscopic submucosal dissection (ESD) technique was used to detect and remove the fish bone entirety.

CONCLUSION

The extraction of fish bone via ESD immediately after the injection of methylene blue into the submucous membrane under EUS guidance to obtain accurate localization of the foreign body may be the best treatment for such patients.

Keywords: Fish bone; Endoscopic mucosal dissection; Upper esophageal wall; Case report

Core tip: It is rare to find the fish bone completely embedded in the wall of the esophagus with endoscopic findings similar to those of submucosal tumors. We report a fish bone that is fully embedded and migrated through the esophageal wall. During the operation, it was found that the fish bone was not directly below the highest point of the mass protuberance. Therefore, it is suggested that submucous injection of methylene blue under endoscopic ultrasonographic guidance can be used to locate the foreign body accurately and reduce the injury of treatment.