Disappearing intraesophageal foreign body: A case report.

Background: Foreign body ingestion is a common emergency in clinical practice. While the majority of cases are resolved following successful removal, rare and unexpected complications can arise, such as the spontaneous displacement of a foreign body during the procedure. This report describes a unique case where a foreign body initially lodged in the esophagus was dropped during the procedure, leading to aspiration and migration to the airway.

Case summary: A 69-year-old Chinese woman presented with a 6-hour history of throat pain and tightness after consuming rabbit meat. She had no fever or bloody stools but had a history of hypertension. Initial imaging, including a neck computed tomography scan, indicated a foreign body in the upper esophagus. Esophageal endoscopy was performed, during which the patient's vital signs remained stable. The procedure showed a 14-cm mucosal erosion with food debris and a visible foreign body located in the gastric fundus. The foreign body was removed with forceps but unexpectedly dropped into the hypopharynx. Subsequent upper gastrointestinal endoscopy did not identify the foreign body. On awakening from anesthesia, the patient exhibited hypoxia and coarse breath sounds, but without coughing. A chest X-ray indicated that the foreign body had migrated into the airway. An emergency fiberoptic bronchoscopy was performed, successfully retrieving the foreign body. The patient recovered without complications.

Conclusion: Endoscopic removal of an esophageal foreign body can cause silent aspiration in elderly patients with absent cough reflexes, necessitating bedside imaging and prompt intervention.