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An unusual cause of dysphagia: Esophageal external compressive stricture caused by abscess

  • Shi-Ze Xiong
    Affiliations
    The First College of Clinical Medical Science, China Three Gorges University, Yichang, China

    Institute of Digestive Disease, China Three Gorges University, Yichang, China.

    Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China.
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  • Tong Sha
    Affiliations
    The First College of Clinical Medical Science, China Three Gorges University, Yichang, China

    Institute of Digestive Disease, China Three Gorges University, Yichang, China.

    Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China.
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  • Wei Liu
    Correspondence
    Corresponding author at: Institute of Digestive Disease, China Three Gorges University, 8 Daxue Road, Yichang 443000, China.
    Affiliations
    The First College of Clinical Medical Science, China Three Gorges University, Yichang, China

    Institute of Digestive Disease, China Three Gorges University, Yichang, China.

    Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China.
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Published:September 22, 2022DOI:https://doi.org/10.1016/j.amjms.2022.09.008

      Case presentation

      A 66-year-old previously healthy woman presented with mild dysphagia for the past 1 week. She denied fever, chest pain, weight loss, and history of gastrointestinal carcinoma and previous surgery. Physical examination was unremarkable with no lymphadenopathy. A computed tomography (CT) scan showed a large and soft tissue density mass in the upper esophagus (Fig. 1A). She underwent upper gastrointestinal endoscopy which revealed a bulging mass with normal looking mucosa in the upper esophageal region at 18 cm from the incisor (Fig. 1B). Endoscopic ultrasound examination confirmed the lesion was about 3.0 cm in diameter and was located outside the esophagus with no recognizable echo patterns (Fig. 1C). An extra esophageal cyst was initially suspected. Endoscopic ultrasound-guided cyst drainage was performed and approximately 10 mL of yellow-brown purulent exudate was aspirated (Fig. 1D). Laboratory tests of the so-called cyst revealed severe neutrophilic leukocytosis (48,469/m3 white blood cells and 16,964/m3 neutrophils), which were entirely consistent with important components of abscess. Further questioning of the patient found that, 3 months ago, she swallowed a fish bone by mistake with no endoscopic intervention. Extraesophageal migration of an ingested fish bone leading to localized abscess is a rare condition.
      Esophageal fish bone foreign body is the most frequent food-associated foreign body in adults and the risk of complications are increased with a longer duration of impaction, bone type and larger bone size.
      • Kim HU.
      Oroesophageal fish bone foreign body.
      Migrated fish bone should be suspected if there is a history of fish bone impaction, is having difficulty swallowing and has a negative endoscopic examination.
      • Custódio SF
      • Branco P
      • Sousa PM
      • et al.
      Migrating fish bone presenting as a neck fistula.
      Proper history taking is of importance in the assessment of the condition to prevent misdiagnosis.
      • Thuduvage VS.
      Migrated fish bone into the neck: a case report.
      Gastroenterologists should be aware that migrated fish bones are not uncommon and that early suspicion may avoid a delayed diagnosis and complications. After symptomatic therapy for this patient, her dysphagia improved spontaneously, with repeat CT showing complete disappearance of the abscess. No episodes were noted in the next several months and follow-up esophagogastroduodenoscopy after 1 year confirmed no recurrence.

      Ethics statement

      The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Written informed consent was obtained from the patient for publication of this “GI Image”. Board institutional approval was not required.

      Author contributions

      Collection of data and writing: Shi-Ze Xiong. Manuscript preparation: Tong Sha. Final approval of the manuscript: Wei Liu.

      Declaration of Competing Interest

      The authors have no conflicts of interest to declare.

      References

        • Kim HU.
        Oroesophageal fish bone foreign body.
        Clin Endosc. 2016; 49: 318-326https://doi.org/10.5946/ce.2016.087
        • Custódio SF
        • Branco P
        • Sousa PM
        • et al.
        Migrating fish bone presenting as a neck fistula.
        BMJ Case Rep. 2021; 14https://doi.org/10.1136/bcr-2021-243622
        • Thuduvage VS.
        Migrated fish bone into the neck: a case report.
        J Med Case Rep. 2021; 15: 452https://doi.org/10.1186/s13256-021-02968-2