A 70-year-old woman presented to the emergency department with acute onset odynophagia after ingestion of a diphenhydramine 25 mg tablet. On initial presentation, she noted spontaneous resolution of her symptoms, tolerated oral intake, and was discharged home with ambulatory follow-up. Five days later, she presented to the gastroenterology clinic with progressive odynophagia, dysphagia with solid foods, and a 24-hour history of fever. She tolerated liquids and oral secretions without issue. Physical examination was unrevealing. A non-contrast computed tomography of the neck and chest identified a metallic foreign body lodged in the esophagus with a possible esophageal perforation at the level of the aortic arch (Figure ). Esophagogastroduodenoscopy revealed a metallic foreign body 20 cm from the mouth (Figure ). Rat-toothed forceps were used to retrieve the object, which was identified as a medication blister pack containing an intact diphenhydramine 25 mg tablet (Figure ). Removal of the blister pack revealed a contained esophageal perforation. The patient was treated with empiric ampicillin/sulbactam, intravenous fluid hydration, and nil per os for several days. Follow-up esophagram demonstrated interval healing of the perforation. Her symptoms resolved, and her diet was advanced without complications.
展开▼
