A rare but life−threatening complication of self− bougienage: iatrogenic esophageal foreign body

for benign esophageal stricture for pa− tients in whom surgery is not feasible [1]. Repeated bougienage by the patients themselves, “self−dilation,” has been proven safe and effective [2]. The major complication of bougienage is esophageal perforation, although the incidence is only 0.04 %±0.2 % [3]. Case. A 74−year−old man, diagnosed as achalasia 7 years ago, underwent routine Maloney esophageal bougienation (tung− sten filled and mercury free; Rusch, Lim− erick, Pennsylvania, USA) (l" Fig. 1) at our outpatient department at regular in− tervals. Unfortunately, the patient mis− swallowed the dilator because of care− lessness on 4 December 2006. Chest radiography was done immediately, and revealed a foreign body in the lower esophagus and stomach (l" Fig. 2). An at− tempt to remove the device with an endo− scopic extractor was made (l" Fig. 3), and rigid esophagoscopy under general anes− thesia was also performed the next morn− ing but in vain. After consultation with a gastrointestinal surgeon, open gastro− nomic surgery was done, and the dilator was finally removed. The patient achieved uneventful recovery and was discharged 6 days later. Discussion. Bougie dilatation is the most widely used modality for inoperable pa− A rare but life−threatening complication of self− bougienage: iatrogenic esophageal foreign body