title: Esophageal obstruction by a lemon that required esophagotomy: thoughts on prevention.
abstract: A patient with pica and Lennox Gastaut syndrome suddenly refused oral intake. Neck radiographs revealed no foreign body. Barium swallow identified an irregular filling defect in the cervical esophagus. Esophagoscopy showed a gold ball-like object (half a lemon) 3 cm distal to the cricopharyngeus. This object had to be removed by esophagotomy after failed attempts with flexible and rigid esophagoscopy, laryngoscopy, and a Foley catheter. The charge for her 39-day hospitalization was $282,761. She had ingeniously procured and swallowed the lemon despite a full-face plastic shield and staff surveillance. In nonverbal persons, medically unexplainable abrupt food-refusal is an emergency. Prevention necessitates attention to pica, impulsivity, dentition, food consistency, eating utensils, seizures, environment, adaptive equipment, and surveillance.
authors.affiliation: Fairview Developmental Center, 2501 Harbor Blvd., Costa Mesa, CA 92626, USA. glohiya@fdc.dds.ca.gov
authors.forename: Gham-Shyam
authors.initials: GS
authors.lastname: Lohiya
authors.forename: Lilia
authors.initials: L
authors.lastname: Tan-Figueroa
authors.forename: Hung
authors.initials: H
authors.lastname: Van Le
authors.forename: Lucia
authors.initials: L
authors.lastname: Rusu
mesh_terms: D000328:Adult; D002957:Citrus; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus; D005260:Female; D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D011859:Radiography