Esophageal foreign bodies and food impaction are a common health problem^1,6, and represent the second most common indication of emergency upper gastrointestinal endoscopy after upper gastrointestinal bleeding¹. Most ingestions are accidental. Children are the most affected age group, followed by adults, although voluntary ingestions may occur in psychiatric patients and inmates. The incidence increases in adults >70 years due to the use of dental prostheses which compromise the tactile sensitivity during swallowing^1-3,6.

Most foreign bodies can spontaneously migrate throughout the entire gastrointestinal tract, although the upper esophagus at the level of the Killian-Jamieson space is the most common site of obstruction due to foreign bodies. Symptoms appear abruptly after ingestion and include dysphagia, odynophagia, sialorrhea, cervicothoracic pain, cough and dyspnea^1-6. A timely diagnosis of esophageal foreign body should be made without treatment delays, as this can result in a significant increase in mortality^1-6.

A 50-year-old otherwise healthy female patient sought medical care due to dysphagia, odynophagia and cervical pain after swallowing a partial denture while having lunch 8 hours before. The patient underwent X-rays and a computed tomography (CT) scan of the neck and chest, which showed a radiopaque image in the upper esophagus at the level of the seventh cervical vertebra, without subcutaneous emphysema or pneumomediastinum (Fig. 1 A and B). The laboratory test reported high white cell count.

Figure 1 A: Neck X-ray, lateral view, showing a radiopaque image (white arrow) at the level of the 7th vertebra (black arrow). B: CT scan. Foreign body (black arrow) in the cervical esophagus without signs of subcutaneous emphysema. 

After consultation with gastroenterology, an upper gastrointestinal endoscopy was performed. The denture was found in the esophagus at 15 cm from the upper dental arch. After attempting to remove it for one hour, the procedure was stopped due to bleeding of the esophageal wall with risk of perforation. A left lateral emergency cervicotomy was performed, with identification of the vascular structures, trachea, left thyroid lobe and esophagus. The esophagus was incised via a transverse incision and the partial denture was removed (Fig. 2 A and C). Primary closure of the esophagus was performed with continuous 6-0 Prolene suture in two suture lines (one total line and one muscular line) (Fig. 2, B). Drains were left in the surgical bed and anterior mediastinum and a nasogastric tube was also placed. The patient evolved with favorable outcome. A barium swallow test made on postoperative day 7 did not show esophageal leaks (Fig. 3). Tolerance to oral fluid and solid intake was good and the patient was discharged.

Figure 2 A: Esophagotomy and visualization of the denture (black arrow). B: Primary closure of the esophagus (white arrow), anterior jugular vein (short white arrow) and left thyroid lobe (black arrow). C: Partial dental removed. 

Figure 3 Barium swallow test with no esophageal leak. The white arrow indicates the level of the suture 

After reviewing the literature, we conclude that most foreign bodies < 2 cm pass the esophagus without causing injuries and, once in the stomach, they spontaneously pass through the rest of the gastrointestinal tract. However, in 10-20% of cases, endoscopic removal is mandatory in patients with esophageal obstruction due to larger foreign bodies, and less than 1% will require surgical treatment^1-6.

The aim of presenting this case report is to show that impaction of the denture in the upper esophagus immediately caused obstruction in a patient with severe symptoms who initially required upper gastrointestinal endoscopy to remove the foreign body. The impossibility of extraction and the presence of esophageal wall bleeding required urgent surgery with esophagotomy and primary esophageal closure as definitive treatment.