Delhi: 61-yr-old swallows pill with aluminium blister foil, saved in rare operation

By Shalini Bhardwaj
New Delhi [India], February 24 : Doctors at Delhi's Sir Ganga Ram Hospital have successfully removed an unusual but dangerous foreign body - a tablet with intact aluminium blister foil stuck in the food pipe (oesophagus), using an innovative endoscopic technique in an elderly man.
Prof Anil Arora, Chairman, at the Institute of Liver, Gastroenterology and Pancreatico-biliary Sciences (ILGPS) at Sir Ganga Ram Hospital said, "A 61-year-old male came to emergency with severe chest discomfort after accidentally swallowing a tablet with intact aluminium blister foil cover. This 'foreign body' had got stuck in the upper oesophagus and hence, he was unable to swallow anything and was repeatedly spitting saliva. An endoscopy was immediately done which revealed a complicated situation."
Dr Shrihari Anikhindi, Consultant Gastroenterologist and Therapeutic Endoscopist at ILGPS elucidated the challenge and said, "The tablet-intact foil was stuck in the narrowest portion of the upper oesophagus which did not allow any room for endoscopic manoeuvring and removal. The aluminium foil was very rigid and had sharp edges. Hence, any forceful removal could have easily injured the oesophagus leading to devastating complications like perforation, bleeding, mediastinal infection and sepsis which would have required an emergency surgery with its attendant complications."
"Since direct removal from the site of impaction (oesophagus) was dangerous, we gently and slowly pushed the tablet with intact foil into the stomach. This gave us ample room for manoeuvring special accessories," Dr Anikhindi stated.
"Once it was inside the stomach, we punctured the aluminium foil using a special endoscopic needle and pushed saline under pressure. This dissolved the inner tablet and all the contents came out of the foil in the stomach cavity. The foil contents were now emptied, and it was possible for us to fold the aluminium foil onto itself. This reduced the diameter and inverted the dangerous sharp edges. Using a special accessory called endoscopic mucosal resection (EMR) cap attached to the endoscope, we were able to safely remove the folded aluminium foil through the mouth. Confronting a difficult and precarious situation, we were glad to perform safe and quick removal of the foreign body using a safe innovative technique," added Dr Anikhindi.
Prof Anil Arora highlighted that it was the second time that they had encountered such a case and had been successful using this approach on both occasions.
Prof Anil said, "Such cases have not been reported in the literature. Since there is no standardised approach to such rare impacted foreign bodies, we had to think out of the box."
"We had to remove a dangerous impacted foreign body while ensuring the safety of the internal lining of the oesophagus, stomach and throat. At Sir Ganga Ram Hospital, we have a well-trained, highly skilled team which is well-equipped to deftly tackle such difficult situations," Prof Anil added.