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Updated: Aug 16, 2026

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Esophageal obstruction by a lemon that required esophagotomy: thoughts on prevention
Gham-Shyam Lohiya1, Lilia Tan-Figueroa, Hung Van Le
1Fairview Developmental Center, 2501 Harbor Blvd., Costa Mesa, CA 92626, USA. glohiya@fdc.dds.ca.gov
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.
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