A Rare Cause of Respiratory Failure in an Alzheimer's Patient: Esophagual Foreign Body

Foreign body impaction in the esophagus is a common emergency, particularly among children; however, unusual presentations in geriatric patients are rarely encountered. The clinical manifestation may vary depending on the type and location of the foreign body and the patient’s underlying condition. We report the case of a 79-year-old bedridden male patient with Alzheimer’s disease who presented to the emergency department with shortness of breath and audible wheezing. Initial evaluation and imaging studies revealed no acute pulmonary pathology. A lateral neck X-ray demonstrated an image consistent with a foreign body at the cervical level, which was later confirmed by computed tomography to extend along the esophagus. Under sedation with fentanyl and ketamine, the foreign body—a sock—was successfully removed using a laryngoscope and long forceps. The patient recovered uneventfully and was discharged after clinical stabilization. This case is remarkable due to the atypical presentation and the unusual nature of the ingested object. While most esophageal foreign bodies in adults are accidental or intentional, this case resulted from unconscious behavior related to Alzheimer’s disease. Emergency physicians should maintain a high index of suspicion when evaluating elderly or cognitively impaired patients presenting with atypical respiratory symptoms, as early recognition and prompt intervention can be lifesaving.