Gastro Case Challenge: A 33-Year-Old Man Who Can’t Swallow His Own Saliva

Juan Carlos Munoz, MD; Carmela Monteiro, MD; Ivan E. Rascon-Aguilar, MD


September 06, 2022

Physical Examination and Workup

Upon physical examination, his oral temperature is 98.6° F (37° C). His pulse is regular at a rate of 105 beats/min. His blood pressure is 120/70 mm Hg. His respiratory rate is 10 breaths/min. The patient is in no acute distress. Although he is noted to be spitting up saliva, he is not drooling, and no stridor, cyanosis, or pallor is detected.

The examination of his head and neck is normal, with no palpable masses or cervical lymphadenopathy. His lungs are clear to auscultation, and the patient has a normal respiratory effort. His heart evaluation demonstrates normal S1 and S2 heart sounds, without any murmurs. His abdomen is soft, nontender, and has normal bowel sounds. No skin is rash noted.

The laboratory findings, including a complete blood cell (CBC) count and a basic metabolic panel, are normal. Plain chest radiographs are unremarkable, with no radiolucent objects or extravasations of air seen. The patient is diagnosed with an esophageal foreign-body obstruction and treated in the emergency department with intravenous fluids and glucagon (Figures 1 and 2). Two hours after this initial treatment, his symptoms persist; a gastroenterologist is brought in for consultation for endoscopy and food bolus extraction.

Figure 1.

Figure 2.


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