(0732) Suicidal Sword Swallowing: Intentional Ingestion of a Sharp Esophageal Foreign Body With Traumatic Esophageal Perforation

Introduction: Esophageal foreign bodies are a common operative issue encountered by otolaryngologists, and their management is made more complex when foreign bodies are rigid, sharp, and pose risk of perforation.

Methods: We present a case of an intentionally swallowed metallic foreign body causing an esophageal perforation and a literature review of management of sharp esophageal foreign bodies in the current literature.

Results: The patient is a 35 year-old male with severe depression and prior suicide attempt involving ingestion of a toothbrush necessitating exploratory laparotomy. He presented to Ben Taub General Hospital emergency room after he intentionally swallowed what he described as a “switchblade”. Patient was found to have a widely patent airway on bedside nasolaryngoscope exam outside of copious bloody secretions in the hypopharynx. CT neck revealed an 8.7 cm foreign body lodged along the right tracheoesophageal groove with associated subcutaneous emphysema.
The patient was taken urgently to the operating room. Direct laryngoscopy and esophagoscopy were completed with no foreign body visualized. A small perforation was visualized in the right piriform sinus. The surgeon then proceeded with open neck exploration, and the foreign body was palpated in the right tracheoesophageal grove. The blade had extruded completely out of the pyriform sinus and was lodged in the soft tissue of the neck and upper chest. The blade was removed in its entirety and identified as a dismantled scissor blade. The esophageal perforation was then closed primarily using interrupted Connel sutures, and the omohyoid muscle was rotated to bolster the surgical repair. The patient was left intubated and given intravenous corticosteroids for 24 hours and then successfully extubated without issue. An esophagram was performed post-operative day 7 with no evidence of a leak.

Conclusions: We detail the successful management of a sharp esophageal foreign body with consequential traumatic perforation, our pre-operative considerations, and post-operative treatment.