Lemon Lodged in Teen's Esophagus Mimics Seizure

A 17-year-old boy with an intellectual disability and unable to speak was rushed to an emergency department in eastern Nepal. The boy’s symptoms—drooling, agitation, and stiffening of his arms—initially suggested a seizure, but the actual cause was a whole lemon wedged in his esophagus. The case, published in March in Clinical Case Reports by doctors at B.P. Koirala Institute of Health Sciences in Dharan, Nepal, shows how a blocked esophagus can pass for a neurological emergency in a patient who cannot describe his symptoms.

Atypical Symptoms Raised Questions

The boy’s mother had brought him to the hospital after noticing abnormal movements, drooling, and signs of throat discomfort for about two hours. She also mentioned that he had hit his head against a wall a few times. Upon arrival, medical staff found his blood oxygen level to be 90% on room air, with rapid breathing at 28 breaths per minute. He had intermittent stiff posturing of his arms and could neither speak nor swallow, prompting high-priority triage.

Initially, the working diagnosis leaned toward a seizure disorder, but a senior clinician expressed doubts due to the atypical symptom pattern for a seizure. Additional clues, such as scratch marks and abrasions around and inside his mouth, suggested that the boy might have swallowed something. His mother’s revelation that he had a habit of putting objects in his mouth further supported this theory.

Imaging Revealed the Unexpected Cause

X-rays of the boy’s head and neck revealed a dense, round shadow at the base of the neck, consistent with an object obstructing the esophagus. The nature of the object became clear during a procedure under general anesthesia, where doctors passed a rigid esophagoscope. The object, a whole lemon, was found impacted in the esophagus. During the attempt to remove it, the lemon slipped into the stomach, relieving the blockage without causing any tissue injury, bleeding, or perforation.

The boy was monitored in intensive care, his symptoms resolved quickly, and he was discharged in stable condition after a brief stay. His caregiver received advice on dietary and home safety, watching for behavioral warning signs, and preventing a repeat episode.

A Recognized Yet Often Overlooked Risk

Children and individuals with intellectual disabilities are at a higher risk of swallowing foreign objects, a situation that can be particularly dangerous for those who cannot communicate what has happened. A 2021 study of neurologically impaired children cited by the Nepal team described how challenging diagnosis and treatment can be in this group. That study reported an average age of about 10 years, with boys affected more often, which made this 17-year-old older than usual.

While many swallowed objects pass through the body without needing medical intervention, large, firm, round objects are a different story. A review of endoscopic management cited by the team stresses treating esophageal obstructions within 24 hours, and the boy’s procedure fell within that window. In some cases, endoscopy is not enough: the authors pointed to a study of esophageal foreign bodies in patients with intellectual disability in which a walnut and a wristband required open surgery after retrieval attempts failed.

Essential Warning Signs for Caregivers and Emergency Responders

The Nepal team’s message is aimed at both clinicians and families. In nonverbal or intellectually disabled patients, sudden agitation, abnormal posturing, drooling, trouble swallowing, or hands repeatedly going to the mouth can signal something stuck in the throat, even when the picture looks neurological.