Doctors Lounge - Surgery Answers
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Forum Name: Surgery Topics
|leapfrogger - Mon Dec 31, 2007 7:13 am|
I was admitted to the hospital on the 26th of this month after going to the emergency room to seek treatment for difficulty swallowing. I can swallow but I tend to choke a lot on things I attempt to eat and drink. This started around July of this year and has progressively got more severe. I have also had issues with waking up multiple times a night due to not being able to take a breath, I think due to positioning of my head/neck. They did blood work, xrays of neck and a CT scan of head and neck. Labs showed dehydration and my nutrition was off but the thyroid panel was normal. The xrays showed nothing. The Ct scan offered information that was unexpected. It showed a foriegn body that was 1.9 CM long positioned in the lining of the wall of the esophagus between C7 and T1 embeeded in the same direction as the esophagus runs. They were not able to indentify it but the report states that it is more dense then bone but not as dense as metal. I was admitted to the hospital and they went down my throat via endoscopy to see if they could find the object. They were unable to locate it via endoscopy so confirmed it is embedded in the wall. After 2 days the ENT dr and GI dr decided that the foriegn body was too low down to be the cause of my swallowing problem and claimed it was due to weak muscles in my esophagus but did not provide me with test results or possible reasons this could be the case.
There was brief discussion about the removal of the foriegn body but they ENT Dr said he or the hospital was not suitable to handle it. I was told that the surgery to remove it would be risky and would have to involve at least 2 surgeons and a long recovery period because they would have to cut from the outside of my neck all the way into the esophagus removing a 2 cm part of the wall of the esophagus. Despite not being able to identify the foriegn body I was told it was not the cause of my swallowing problem and would be best left intact. I was discharged and told to seek further medical care if my swallowing problem continued or got worse. I am concerned about this and wondering if you have any information or opinions reguarding the possible consequences of leaving this foriegn body intact given the current issues and lack of information.
Sorry if this was too long.
Thank you for taking the time to read and respond to my question.
29 yr old male
paraplegia- Transverse Myelitis diagnosed 2002
recurrent blood clots- tx with lovenox
Hypertension- tx toprol xl, verapamil er, zestril
seizures due to closed head injury- unable to control with meds
congenital heart defects involving valvles
lung disease- alpha-1 antitrypson defficiency
|Dr. Chan Lowe - Sat Jan 12, 2008 11:23 pm|
There is another test called a barium swallow that can better evaluate the ability of the musculature of the esophagus to properly function. Basically, you would drink some radioopaque dye (barium or a similar contrast) and x-ray pictures would be taken while you were swallowing to assess the function. This test may help confirm the muscular weakness if this is the cause of your difficulty swallowing.
If the foreign body is, indeed, not causing you any problems it may very well be safer to keep it in place. Given the location you are describing, I suspect that you may need a cardiothoracic surgeon or an ENT doctor experienced in surgeries at this depth of the esophagus.
|leapfrogger - Sun Jan 13, 2008 3:37 am|
Hi Dr Chan Lowe.
I appreciate your responce. I have had the barium swallow done once before to evaulate the Gerd related issues I think.. I have no bowel control/sensation and I don't take any measures to ensure regular bathroom habbits untill close to the 2nd week mark and I ended up with a partial bowel obstructiion within a week of the barium swallow. That whole experience has made me shy away from the barrium swallow. I know there is another type of liquid that can be drank but I have been told it has the potential to be just as problematic as far as constipation goes and is unpredictable.
I was under the belief they could evalute throat muscle weakness via endoscopy too but I am assuming now that this isnt accurate. They did not do a barrium swallow test so Im not sure why they were so quick to write it off as weakness in the muscles.
The exact wording of the ct repot is as follows..
An abnormal density is projected in the prevertebral tissues just anterior to C7 and T1. Sagittal and coronal reconstructions were produced and confirmed that this density is greater then bone density but appears to be less then metallic density on the previous plain film. It is slender in shape and measures 1.9 cm in length, running parallel to the esophageal lumen. It appears to be associated with the right lateral aspect of the cervical esophagus and is most consistent with a submucosal or intramural foriegn body.
The second ct scan report words it a little differently
CT images show an abnormal radiodense foriegn object just anterior to C7 and T1. This is visable on the AP view as a linear density projected just to the right of the midline through the body of T1. This does not appear to be a metallic density on these plain films but is more dense them bone on the CT scan. This measures approximately 2.1 cm in overall length
I do have a few follow up questions. If you are able to shed some light on them it would be appreciated. If not that is ok too.. Is there a specific reason why nobody is able/willing to point to the location on my body when I ask where exactly it is? I am assuming theres a logical reason why they cant just point to the spot on my neck and say its right around "here"! I know our bodies are shaped different but I am assuming the skeletol system is pretty simuliar from person to person.
And should I be concerned about MRI type scans in the future since the non contrast ct scans stated it not a metallic object? Radiodense means safe for MRI scans? I just don't wanna end up having this thing ripped out by a MRI in the future.
Soon as my insurance coverage is sucessfuly transfered to this county I will be able to chose a primary care dr, but can you suggest things I can do in the mean time to cut down the risk of developing pnemonia related to injesting liquid and food stuff into airways? Is it likely Ill maintain some level of pnemonia despite antibitic treatment because of this? I know I was diagnosed with pnemonia and put on a vent for 6 days in july but they were unable to clear it up fully and I still had pnemonia when I went home. The hosital stay at the end of December showed I still have it but they did not put me on antibiotics. I am not sure if it the a new case or the same one from months ago. I am following the recent hospitals advice to consume pureed solids and add thickeners to liquids but still choke quite a bit.
I appreciate the time you have put into my issue. Thank you.
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