1753 An “Eggstra-Ordinary” Cause of Esophageal Food Impaction: Esophageal Eggshell Food Impaction

Abstract

INTRODUCTION: Food bolus impactions are commonly encountered GI emergencies, often from impacted meat. We report two patients with esophageal eggshell impaction who presented predominantly with chest pain and odynophagia. CASE DESCRIPTION/METHODS: Case 1: An 88-year-old female with a history of gastroesophageal reflux disease, prior hiatal hernia repair, and intermittent dysphagia to solid food presented to the emergency department with intermittent severe, sharp chest and epigastric pain that occurred with swallowing 30 minutes after eating a hard-boiled egg. The patient could not handle secretions due to dysphagia and had several episodes of non-bloody emesis. Chest x-ray was unremarkable. Gastroenterology was consulted, and she underwent EGD. A rectangular piece of eggshell was found in the middle third of the esophagus. The eggshell was grasped with standard forceps and pushed into the stomach without difficulty. No esophageal lesions or erosions were noted in the esophagus. Case 2: A 26-year-old female with a history of chronic intermittent reflux symptoms presented to the emergency department with sharp midsternal chest pain upon swallowing that started after she drank egg whites. She was found to have an elevated D-dimer, and a CT Angiogram Chest was obtained in the emergency department which revealed a calcified foreign body within the mid-esophagus at the level of the carina. The patient denied any history of dysphagia. Her physical exam was unremarkable. Gastroenterology was consulted, and EGD was performed, showing a piece of eggshell, which was extracted using rat tooth foreign body forceps. The patient had a healthy mucosal appearance of the esophagus. DISCUSSION: Eggshell food impaction is rarely documented in the literature. In both cases, we describe, chest pain/odynophagia as a predominant symptom, although one patient did describe concomitant dysphagia. The eggshell foreign body was visible on a CT scan, perhaps due to the calcified nature of the shell. Thus, this calcified eggshell could potentially be mistaken for an impacted bone fragment in the esophagus on imaging studies. However, the eggshell was not seen on a routine chest x-ray in the other case. Endoscopic management was achieved by grasping the eggshell with standard forceps and pushing the eggshell into the stomach by extraction of the eggshell using foreign body forceps. Neither patients exhibited erosions caused by the impacted eggshell, despite the presence of sharp edges.