Endoscopic extraction of a fish bone with a Foley catheter after endovascular stent graft placement for penetrating aortoesophageal injury.

A 55-year-oldmanwas admittedwith retrosternal pain and odynophagia of 5 days’ duration. The patient had ingested a fish bone just before the onset of symptoms. He had a 4-year history of coronary artery disease and myocardial infarction. Computed tomography showed a foreign body penetrating through the esophagus into the thoracic aorta (●" Fig.1). No signs of mediastinitis were identified. After a multidisciplinary discussion, endoscopic bone removal was planned with simultaneous endovascular stent graft placement. A 34×180-mm stent graft was implanted in the thoracic aorta via the femoral artery (●" Fig.2a). Gastrointestinal endoscopy revealed a fish bone lodged in the esophagus at 250mm from the incisors. Both ends were impacted in the esophagus, with a short segment in the lumen (●" Fig.2b). Despite numerous attempts at removal with a foreign body forceps, neither end could be separated from the esophageal wall because of the narrow space. It was impossible to cut the hard bone endoscopically. As a last attempt before surgery, a 14Fr Foley catheter was introduced beyond the bone. The catheter was inflated with 15mL of normal saline, dilating the portion of the esophageal lumen distal to the bone (●" Fig.2c). The bone, which was almost 40mm long with two pointed ends (●" Fig.2d), was then separated and extracted. A nasojejunal feeding tube was placed. The patient’s postoperative recovery was uneventful (●" Fig.3). Several instruments have been used to retrieve foreign bodies, including forceps, polypectomy snare, and Roth basket. A major disadvantage of these tools is their limited ability to overcome anatomical obstacles [1]. A Foley catheter is usually used under fluoroscopic guidance to remove blunt foreign bodies from children [2]. In our case, we used this simple and primitive type of catheter to dilate the esophagus before bone removal. The use of a Foley catheter is an option for extracting sharp objects with two ends impacted in the esophagus.