2017 Volume 53 Issue 6 Pages 1195-1199
A two-year-old boy underwent esophagogastroduodenoscopy (EGD) owing to possible gastroesophageal reflux, which was suspected because he had been frequently vomiting since he was 6 months old. A foreign body was found in the upper esophagus, and the patient was diagnosed as having a long-standing foreign body in the esophagus. Endoscopic removal was attempted but was unsuccessful because the foreign body was deeply invaginated into the esophageal wall, making it difficult to grasp it. Computed tomography revealed an abscess in the upper mediastinum. Gastrostomy was performed to allow the esophagus to rest. The combined use of an endoscope and a thoracoscope was planned to remove the foreign body either from the esophagus or through the thoracic cavity, depending on how the foreign body was actually invaginated. It was difficult to grasp the foreign body with forceps using an endoscope or a rigid scope. A thoracoscope allowed us to identify an abscess cavity but it was difficult to determine the boundary of the cavity with the esophageal wall. Under endoscopic guidance, the abscess cavity wall can be identified and incised to sample pus without damaging the esophageal wall. By inserting the forceps at this site, we were able to push the foreign body back into the esophagus and then remove it successfully with the forceps under endoscopic guidance. The combined use of an endoscope and a thoracoscope allowed for a flexible approach from the inside and outside of the esophagus, facilitating the removal of the foreign body safely and reliably.
