Woman With Food Bolus Impaction is Given Oral Gastrointestinal Treatment Prematurely

This case involves a woman who presented to the hospital with chest pain and shortness of breath after eating. She was diagnosed with food bolus impaction and her shortness of breath continued to worsen. The physician ordered a CT angiogram to rule out an esophageal tear but before the results were back, the woman was given an oral gastrointestinal cocktail which exacerbated her trouble breathing. The CT angiogram results then came back with the finding of an esophageal tear. The woman developed respiratory distress syndrome and suffered a collapsed lung as a result of the complications. An expert in gastroenterology was sought to discuss the standard procedure for patients with food bolus impaction.

Question(s) For Expert Witness

1. What specialist(s) should be consulted if a food impaction is suspected?

2. What is the standard procedure when a patient is diagnosed with food bolus impaction?

Expert Witness Response E-004817

As part of a major teaching medical school in Texas, I see foreign body ingestions monthly and manage them with ENT and thoracic surgery with GI managing 95% of resolutions. ENT usually evaluates above the upper esophageal sphincter with thoracic surgery managing the cases that need a thoracotomy. GI clears the esophagus of the bolus and manages the associated defect -- Shatzski ring, stricture, cancer, motility disorder, eosinophilic esophagitis, or anything else causing the food impaction. In a standard workup, the patient needs to have a thorough history and have a physical exam done. Labored breathing is not a common symptom in patients presenting with food impaction unless there is total esophageal obstruction of the distal esophageal tear. Plain radiographs are standard of care studies and CT scanning can be beneficial if plain films are negative. Gastroenterologists are called to assess when and if an endoscopy is indicated. Emergent endoscopy is indicated for patients having trouble handling oral secretions. The patient's labored breathing is bothersome and suggests a complication and need for an emergent consultant with GI who would likely consult surgery.