Pneumocephalus is a rare complication of esophagogastroduodenoscopy (EGD), but existing literature does not discuss
pneumocephalus surrounding endoscopic food bolus retrieval. We present a death involving
pneumocephalus complicating endoscopic food removal from the esophagus. A 40-year-old man presented with
dysphagia and suprasternal discomfort 12 hours following chicken ingestion. On flexible endoscopy, chicken was visualized in the distal esophagus. After successful retrieval, a mucosal
laceration was noted where the chicken had been lodged. He was unarousable following the procedure and was emergently transported to a hospital, where computed tomography scanning showed
pneumocephalus. He was later declared
brain dead. The case was referred for medicolegal autopsy. The brain was examined first, revealing rare air bubbles within meningeal vessels and numerous, diffuse
petechiae-like
hemorrhages within the brain parenchyma. The esophageal mucosa had focal discoloration and a partial thickness
laceration; microscopic examination revealed
eosinophilic esophagitis.
Eosinophilic esophagitis is a known risk factor for food bolus impaction and should be suspected in such patients.
Pneumocephalus is a rare possible complication of EGD for food bolus retrieval. In patients unresponsive after endoscopy, radiographic detection of potential
pneumocephalus should be encouraged to enable timely
therapy and improved outcomes, or to supplement autopsy in the event of patient death. Forensic pathologists should understand that
pneumocephalus is a potential mechanism of injury/death in patients experiencing esophageal
trauma, including injury incurred during EGD.