Mussel shell impaction in the esophagus

Abstract

Mussels are commonly used in cooking around the world. The mussel shell breaks more easily than other shells, and the edge of the broken mussel shell is sharp. Impaction can ultimately cause erosion, perforation and fistula. Aside from these complications, the pain can be very intense. Therefore, it is essential to verify and remove the shell as soon as possible. In this report we describe the process of diagnosing and treating mussel shell impaction in the esophagus. Physicians can overlook this unusual foreign body impaction due to lack of experience. When physicians encounter a patient with severe chest pain after a meal with mussels, mussel shell impaction should be considered when diagnosing and treating the patient.

Keywords: Endoscopy; Esophagus; Mussel shell impaction; Mussels.

Fig. 1

In a plain neck lateral film, an approximately 2-cm-sized radiopaque linear flat foreign body (arrow) at the level of the 6th and 7th cervical vertebrae could be clearly identified. No bony or soft tissue abnormalities were demonstrated.

Fig. 2

Cervicothoracic computed tomography showed a highly attenuated, bone like, thin linear material impacted inside the cervical esophagus at the level of 6th to 7th cervical vertebrae. There were no definite complications caused by foreign body impaction, such as perforation and abscess.

Fig. 3

Esophagoscopy demonstrated a blackish fragment impacted in the esophagus. The piece of the shell was impacted tightly and did not move easily when the endoscopist touched it with a forceps. We used a bag when extracting the shell to avoid damaging the esophagus and upper esophageal sphincter.

Fig. 4

The extracted piece of mussel shell had a triangular shape with very sharp edges. The shell was about 2 cm in size. These sharp edges may cause serious pain and tight impaction in the esophagus.