A Case of Successful Conservative Treatment of Esophageal Perforation from Penetration of Esophageal Wall by a Fish Bone

Abstract

A 71-year-old m an with a history of percutaneous transluminal coronary angioplasty (PTCA) was referred to our clinic with a o ne-day h istory o f a c ontinuous s ubsternal c hest p ain radiati ng to h is le ft s houlder. In retrospect, h e e xperienced chest discomfort after eating fish one day before but did not seek m edical attention then. A n upper gastrointestinal endoscopy w as p erformed. T he c ause w as n ot visible d uring th e a dvancement o f th e e ndoscope th rough th e e sophagus, b ut a small segment o f a fish b one p rotruding fro m a n u lcerative le sion in th e lo wer e sophagus w as identified w hile w ithdrawing the endoscope. The fishbone w as im medi ately removed. A follow-up C T scan revealed pneumomediastinum. N ow h emodynamically s table, th e p atient u nderwent conservative m edical treatment in cluding to tal parenteral nutrition (TPN) and intravenous antibiotic drugs. The patient m ade complete recovery. W e report a case of a 71year-old m ale found to have an esophageal perforation from an ingested fish bone, w hich w as m anaged s uccessfully with c onservative treatment. A p ertinent lite rature review is a lso in cluded. Key W o rds: F oreign b odies, E sophageal p erforation, M ediastinitis