Esophageal Obstruction and Death in a Nonverbal Patient.

Title

Esophageal Obstruction and Death in a Nonverbal Patient.

Creator

Yocum AD; Dennison JL; Simon EL

Publisher

The Journal Of Emergency Medicine

Date

2021
2021-02-11

Description

BACKGROUND: There are more than 100,000 cases of esophageal foreign body in the United States each year. Most cases resolve spontaneously; however, complete esophageal obstruction is a medical emergency. Patients with developmental disabilities are at high risk, because a large percentage of this population is effected by dysphagia, pica, tooth loss, or impulsive swallowing. In some cases, the diagnosis of esophageal foreign body can be made clinically, with the typical presentation including coughing, inability to tolerate secretions, drooling, vomiting, and dysphagia. In other instances, imaging is needed to confirm the diagnosis. CASE REPORT: A nonverbal adult patient with history of mental retardation and dysphagia presented to the emergency department (ED) after a choking episode with persistent coughing. An x-ray study of the chest showed mild opacity at the left lung base and she was discharged with antibiotics. She returned to the ED that day with worsening symptoms suggestive of aspiration pneumonia. A computed tomography scan of the chest revealed numerous cylindrical objects in the esophagus, later identified as crayons. At least 28 crayons were removed via 3 endoscopies. During this time, the patient developed aspiration pneumonia, respiratory distress, and septic shock. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Delayed recognition of foreign body puts patients at risk for esophageal perforation, aspiration, airway compromise, infection, sepsis, and death. In nonverbal patients presenting with upper respiratory symptoms, it is especially important to consider esophageal foreign body in the differential diagnosis, because this group is high risk for missed diagnosis and complications secondary to the foreign body.

Subject

sepsis; nonverbal; esophageal foreign body; esophageal obstruction

Format

journalArticle

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Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

ISSN

0736-4679

NEOMED College

NEOMED College of Medicine

NEOMED Department

Department of Emergency Medicine
NEOMED Student Publications

Update Year & Number

March 2021 List

Author(s) ORCID iD

Cleveland Clinic Akron General Hospital

Citation

Yocum AD; Dennison JL; Simon EL, “Esophageal Obstruction and Death in a Nonverbal Patient.,” NEOMED Bibliography Database, accessed June 13, 2021, https://neomed.omeka.net/items/show/11606.

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