History and admission findings: We report the case of a 79-year old male patient with progressive dysphagia 9 years after resection of an adenocarcinoma of the esophagus. The patient presented with cachexia and a weight loss of 10 kg within the last 10 weeks. He was unable to swallow solids and liquids. 6 weeks before he had suffered from pneumonia caused by aspiration. Two previously performed gastroscopic examinations had documented a stenosis of the anastomosis which was passed by the endoscope. Tissue specimens taken from the stenosis showed high-grade dysplasia.
Investigations: Computed tomography of the thorax documented a stenosis of the esophagus with prestenotic dilatation and intraluminal food. There were no signs indicating local recurrence of the tumor such as transmural lesions.
Diagnosis, treatment and course: Endoscopic examination showed an impacted foreign body measuring 2 x 4 cm which was be extracted. Extracorporeal inspection of this foreign body revealed it to be a dried apricot. After retaking the history, the patient was able to date the time of ingestion to have been three months earlier, shortly before his dysphagia had started. After extraction of the foreign body dysphagia resolved and the patient gained weight.
Conclusion: Ingestion of foreign bodies or a food bolus may occur unnoticed on rare occasions and even large ones may remain undiagnosed despite repeated endoscopic examinations.