When Endoscopy Is Needed for a “Stone Heart”

Abstract

An 18-year-old woman presented to the emergency department with dysphagia for 5 days. She had a neurodevelopmental disorder with poor social and motor skills. Her physical examination was unremarkable, except for pallor. Blood investigations revealed microcytic hypochromic anemia (hemoglobin 87 g/L). Chest x-ray showed a heart-shaped opacification in the superior mediastinum (a). A lateral view of the chest x-ray confirmed the lesion in the retrotracheal location (b). Endoscopy showed a large black impacted stone in the upper esophagus (c). Removal of the stone was unsuccessful using a grasping forceps, basket, or retrieval net. A double catheter balloon technique was tried with a double-channel therapeutic endoscope. The first catheter balloon was inserted anteriorly, and the second catheter balloon was placed posterior to the stone. Both the catheters were withdrawn under endoscopic vision, and the stone was retrieved (d). Endoscopic examination at the impacted site showed a circumferential ulcer. A water-solution contrast study of the esophagus revealed no contrast leak. The patient was started orally and discharged. Endoscopic removal is the first-line treatment in foreign body ingestion. The approach to removal should be individualized based on the complexity of the foreign body. Surgical intervention is warranted in complications such as perforation or in cases of failed endoscopic removal. The double-balloon technique came to rescue in this case. (Informed consent was obtained from the patient's next of kin for this case report.