Accidental ingestion of plastic from takeaway containers — food for thought

To the Editor: We read with interest the case report by Guirgis and colleagues.1

Recently, we examined a 62-year-old man with a 20-day history of dysphagia with solids and odynophagia. He did not recall ingesting any foreign body, and his medical history and physical examination were unremarkable.

Upper gastrointestinal endoscopy showed a plastic membrane-like foreign body with sharp edges impacted just above the lower oesophageal sphincter and causing injury to the surrounding mucosa (Box, A). The endoscope could easily pass distally, and the subsequent gastroduodenoscopy did not show any mucosal lesions. A flexible overtube was placed just above the foreign body, which was then captured using rat-tooth forceps. As it was larger than the overtube diameter, the foreign body was initially folded, then wedged into the overtube and safely extracted.2 The ingested body was an arrow-shaped, stiff plastic membrane with sharp edges, measuring 3.5 cm × 2 cm (Box, B). The patient denied consuming food directly from takeaway containers. Therefore, the foreign body may have been part of a snack food package, as the patient reported that he frequently ate packaged snacks. After the foreign body had been removed, two lacerations were visible at the site of impaction (Box, C). The patient reported complete relief of his symptoms and was discharged immediately after endoscopy on oral proton-pump inhibitor treatment.

Oesophageal complications due to swallowed sharp foreign bodies include perforation, fistula formation, mediastinitis, and even aortic rupture. Such complications warrant urgent endoscopic intervention, which represents a challenge if the foreign body is larger than the diameter of the overtube.