Monday, November 11, 2013

The man who swallowed a fork

Sticking a fork in your throat isn't exactly a brilliant idea, is it? Well, apart from triggering the gag reflex, it can have unforeseen consequences. A while ago, I wrote a post about the plight of two 17th-century men who had swallowed knives. Today, I'm going to present the modern case of a man who swallowed a fork. 

The presence of a foreign body in the esophagus (the tube that runs from the throat down to the stomach) is an urgent medical emergency. The swallowing of various foreign objects is most common among children aged from 6 months to 6 years, who swallow coins, toy parts, safety pins and small batteries while playing. In adults, when something gets swallowed and stuck in the esophagus, it's usually an object that was ingested together with food, such as a meat bone, a fish bone (these can be extremely insidious) or something that is normally placed in the mouth, e.g. a denture or a toothpick. When an adult ingests a foreign body, some sort of predisposing factor is often present, such as dentures, decreased sensitivity of the mucosa in the mouth and throat, or neurological diseases. 

Mevio and Mevio (2013) report the unusual case of a 62-year-old man who staggered into a hospital emergency room in Magenta, Italy, visibly drunk, complaining of hypersalivation, inability to swallow and difficulty breathing. He reported that he had been touching the roof of his mouth with the handle of a table fork in an attempt to stop persistent hiccups and in so doing had accidentally swallowed the fork. (This sounds quite similar to the 17th-century case of Andreas Grünheide, who managed to swallow a pocket knife while under the influence of liquor. He had been trying to use the knife to trigger vomiting.)

A chest X-ray showed the fork, 22 centimeters long, stuck in the esophagus and looking quite impressive. It was removed under general anesthesia and the patient was discharged on the second day after surgery, after a swallow contrast study showed a normal esophagus.

 X-rays showing a table fork occupying the esophagus. Image from: Mevio and Mevio (2013)

A fork in the esophagus is quite a medical rarity (somehow, this doesn't surprise me at all). At the time when this article was published, only three cases had been described in medical literature. Two of these patients, suffering from eating disorders, were trying to trigger vomiting using the handle of the fork to irritate their throats when the fork accidentally slipped into the esophagus. (I still have no idea how this can happen accidentally, but obviously it can.) The third patient, like the one described here, was trying to use a fork to stop hiccups. In all cases, the fork presented with the prongs pointing up and was removed. 

Source: Mevio E, Mevio N. (2013) Unusual Esophageal Foreign Body: A Table Fork. Case Rep Otolaryngol. 987504. Published online 2013 March 24. doi: 10.1155/2013/987504

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