A 68-year-old man presented to our hospital with dysphagia due to food impaction 48 hours ago. The patient gave a history of liver transplantation four years ago, regular sclerotherapy for esophageal varices, and food impaction {multiple times (a total of 5 with endotherapy each time)}. The patient underwent upper digestive endoscopy. The scope revealed a large bolus of food (meat). Multiple trials using foreign body forceps but without any success. The patient was intubated under general anesthesia, a gush of water was then applied to the impacted bolus of food, and within seconds, the bolus of food was pushed into the stomach (the use of water is a piece of advice from my assistant Mr. Abdalla). We didn't apply water at the beginning of the procedure to avoid lung aspiration as the patient wasn't anesthetized nor intubated.
Notes on the present case:
1- Roth net is a good option for the removal of the impacted bolus of food (not available in our unit).
2- It is better to intubate the patient under general anesthesia from the start.
3- As this is an impacted bolus of food, so we did not need to retrieve it from the stomach.
4- I think the problem in this patient is the fibrosis of the esophagus due to recurrent sclerotherapy (the tube is transformed from a functional peristaltic tube with mucus covering the lining epithelium to a rigid fibrosed tube); you can notice the multiple mucosal tags.
Notes on the present case:
1- Roth net is a good option for the removal of the impacted bolus of food (not available in our unit).
2- It is better to intubate the patient under general anesthesia from the start.
3- As this is an impacted bolus of food, so we did not need to retrieve it from the stomach.
4- I think the problem in this patient is the fibrosis of the esophagus due to recurrent sclerotherapy (the tube is transformed from a functional peristaltic tube with mucus covering the lining epithelium to a rigid fibrosed tube); you can notice the multiple mucosal tags.
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