S4346 Recurrent Foreign Body Ingestions Resulting in an Unretrievable Esophageal Foreign Body

Introduction: Ingested foreign bodies are a common gastrointestinal emergency, often seen as accidental ingestions with food. Recurrent foreign body ingestions, however, are defined by the repeated and often intentional ingestion of non-food items and are often secondary to mental health disorders. Complications such as ulceration, perforation, and fistula formation at various places within the gastrointestinal tract can occur through recurrent foreign body ingestions, ultimately resulting in numerous endoscopic challenges, including with retrieval of the foreign bodies. Here, we present the case of a 39-year-old man with documented history of recurrent foreign body ingestions. Case Description/Methods: A 39-year-old man with documented history of schizophrenia and over 30 prior foreign body ingestions, including toilet paper rolls, cardboard, and plastic bottles, presented for evaluation of an esophageal mass. The patient had a 2-month history of progressively worsening dysphagia to solids, with associated vomiting and coughing. On imaging, a computed tomography of the chest showed a mass-like thickening of the esophagus with presence of the foreign body and a computed tomography of the soft tissue of the neck showed soft tissue attenuation within the esophagus, suggesting a non-radiopaque foreign body. Esophagogastroduodenoscopy revealed a circular foreign body in the upper esophagus along with circumferential ulceration. The foreign body was lodged into the esophageal wall secondary to the trauma and ulceration of prior foreign body ingestions. As such, esophagogastroduodenoscopy was unsuccessful in removal and the patient was then referred for surgical removal. Discussion: The prevalence of foreign body ingestion is more common in adults with psychiatric disorders, than in those without, as around 79%-85% of intentional foreign body ingestion cases involve patients with psychiatric disorders. Recurrent foreign body ingestions are also more common in the psychiatric population, and are more likely to result in trauma, ulceration, and other pathological changes of the gastrointestinal tract. These alterations to normal anatomy can result in impaction of foreign bodies within the gastrointestinal tract, leading to significant challenges to endoscopic intervention, often necessitating surgical assistance, as seen in our patient. A review of literature shows the rarity of this, as only about 1-3% of esophageal foreign bodies are irretrievable by endoscopic intervention, requiring surgery.