An unusual foreign body in the upper aerodigestive tract: esophageal obstruction due to bran impaction

T. Losacco, R. Cagiano°, P. Luperto*, I. Bera**, L. Santacroce§

Department of Dentistry and Surgery, Chair of General Surgery, Medical Faculty, University of Bari (Italy); °Department of Pharmacology and Human Physiology, Medical Faculty, University of Bari (Italy); *Health District ASL/Br1 – ENT Service, Brindisi (Italy); **Anesthesiology and Intensive Care, Spitalul Clinic Judetean de Urgenta, Timisoara (Romania); §Department of Internal Medicine, Immunology and Infectious Diseases, Medical Faculty, University of Bari (Italy)

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• Gastroenterology

Foreign bodies of the upper aerodigestive tract are common problems encountered by the otolaryngologist and general surgeons. While the diagnosis seems straightforward, it is sometimes delayed until after serious complications have occurred. The treatment of choice is endoscopic retrieval under general anesthesia. The procedure should be preceded by the completion of appropriate studies (radiographic and other specifically indicated for the patient) planned and performed by the endoscopy team. Time invested in preparation and planning will usually yield a speedy recovery of the patient. Bran is a natural fiber that undergoes considerable expansion and thickening when hydrated. Due to this property, it has been used in “weight loss” tablets that in the stomach undergo expansion and are expected to cause early satiety. These tablets are usually marketed as over-the-counter (OTC) diet products by a number of pharmaceutical manufacturers. These supplements consisting primarily of dietary fibers, so common and inoffensive-seeming, rarely may have severe side effects, such a sudden esophageal obstruction. We report a case of a bran dietary product impacted in the cervical esophagus in a 45 year old woman, presenting as an emergency complaining of retrosternal discomfort and difficult to swallow or drink. The technique for removal of such object that is also reported.

Corresponding Author: Tommaso Losacco, MD; e-mail: t.losacco@doc.uniba.it

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