CHENNAI: We have heard stories about kids swallowing small plastic buttons, coins, beads or whatever they could lay their hands on, and getting it out in stools a couple of days later. But when this teenaged mentally challenged boy swallowed a plastic water bottle cap, it needed more than just an X-ray to find out where it was lodged.
Nobody at home had any idea how Bhuvanesh (19), son of a security guard, Gopinath from Kancheepuram, swallowed the bottle cap on the night of July 7. Though he had a sleepless night with pain in his chest, he disclosed it to his mother Suganthi only the next morning.
Suganthi immediately rushed him to a nearby hospital, where they took an X-ray and found out that the cap was stuck in the esophagus or food pipe in the upper chest. With minimum facility available, they did a barium swallow, wherein the teen was given barium sulfate that is opaque to X-ray. Doctors finally found out that the cap was lodged in the food pipe, exactly below the collar bone in the upper chest area.
As it required the intervention of experts from a tertiary care, doctors referred him to the Rajiv Gandhi Government General Hospital (RGGGH).
On July 10, a team of medical gastroenterology and surgical gastroenterology experts attempted to remove the object through endoscopy, which is done with the help of an instrument inserted through the mouth. With Bhuvanesh not cooperating, doctors had to give him general anesthesia through the nose leaving his mouth free.
“We tried various types of endoscopic retrieval devices like graspers, forceps, baskets, balloons and everything, but we could not grasp the object. We felt that making further attempts would only push the object further in to the food pipe. So, we went for a surgery,” explained Dr S M Chandramohan, HoD, Surgical Gastroenterology Department, MMC and RGGGH.
With a six-centimetre incision on the neck, doctors were able to pull the cap out without causing injury to the food pipe during the surgery. The ulcerations that were caused due to the object in the esophagus were also set right. “If the cap was lodged in the foodpipe in the neck area, it would have been easy to remove. Even if it was in the abdomen, it would not have been so tough to remove it through surgery. But it is generally not safe if it is in the chest area as there are vital structures close to it like the lungs on either side, heart in the front, respiratory passage and the main blood vessel aorta at the back. We also avoided opening the chest,” the surgeon explained. Bhuvanesh has now recovered and ready to go home. “He was lying down flat and had consumed water. I don’t know how he swallowed the cap. But he is fine now and eating normally,” said Suganthi.