Endoscopic submucosal dissection for drainage of esophageal abscess with fish bone extraction

Background and Aims

Foreign body ingestion with submucosal penetration presents a challenging clinical scenario. We present a case of successful endoscopic submucosal dissection (ESD) for removing an embedded fish bone with drainage of an associated submucosal abscess.

Methods

A 49-year-old woman presented with odynophagia after fish bone ingestion. Computed tomography scan identified a linear density in the upper esophagus. After an initial negative esophagogastroduodenoscopy, a repeat procedure revealed a submucosal abscess. The ESD technique was used to drain the abscess and retrieve the fish bone.

Results

The fish bone was successfully removed using ESD technique without immediate or delayed adverse events. Postprocedure management included antibiotics, proton pump inhibitor therapy, and dietary modification. Follow-up esophagram confirmed absence of fistula or abscess.

Conclusions

This case demonstrates the importance of careful endoscopic assessment and the utility of ESD technique in managing superficial esophageal abscesses. ESD is a safe and effective technique for removing embedded esophageal foreign bodies within the submucosa.