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Revista Española de Enfermedades Digestivas

Print version ISSN 1130-0108

Rev. esp. enferm. dig. vol.108 n.9 Madrid Sep. 2016




The missing piece



Andreia Albuquerque, Margarida Marques and Guilherme Macedo

Department of Gastroenterology. Centro Hospitalar São João. Porto, Portugal



A 59-year-old female, without a relevant past medical history or medication intake, was admitted to the Emergency Department due to sudden dysphagia after having eaten bread and the suspicion of food impactation.

An upper endoscopy revealed an indeterminate, bluish foreign body in the mid esophagus (Fig. 1) that was extracted with a forceps. After removal, it was clear that it was a puzzle piece (Fig. 2). The patient recalled that, earlier that day, she had been playing with a puzzle with her granddaughter, while she was eating bread.




Puzzle pieces as an ingested foreign body in the adult population are very uncommon. The most common cause of esophageal foreign body obstruction in adults is meat bolus impaction above a pre-existing distal esophageal ring, peptic or malignant esophageal stricture, or eosinophilic esophagitis (1). The majority of foreign body ingestions occur in the pediatric population; in adults, individuals with psychiatric disorders, development delay, alcohol intoxication and incarceration are more prone to foreign body ingestion. The majority of ingested foreign bodies pass spontaneously and mortality rates are extremely low (2).



1. Triadafilopoulos G, Roorda A, Akiyama J. Update on foreign bodies in the esophagus: Diagnosis and management. Curr Gastroenterol Rep 2013;15:317. DOI: 10.1007/s11894-013-0317-5.         [ Links ]

2. ASGE Standards of Practice Committee, Ikenberry SO, Jue TL, et al. Management of ingested foreign bodies and food impactions. Gastrointest Endosc 2011;73:1085-91. DOI: 10.1016/j.gie.2010.11.010.         [ Links ]