Cervical esophagotomy for removing a retained foreign esophageal body

Abstract

The current paper presents the case of a patient with a retained foreign esophageal body, removed through open surgery (lateral cervical esophagotomy). The foreign body was a partial dental prosthesis with a metal hook that anchored it to the patient’s remaining natural teeth. The foreign body was lodged in the esophageal wall and the previous endoscopical extraction attempt had failed. The patient was transferred to our department from a regional hospital where an endoscopic attempt at removing the foreign body had failed. The patient complained of descending odynophagia and dysphagia for solids. After the previous esophageal endoscopy, the patient complained of retrosternal pain and pressure. A CT-scan with contrast of the neck and chest regions was performed. A secondary endoscopical exploration of the esophagus was performed, thus the foreign body’s location was precisely identified. We discovered that its metal grappling device was anchored in the lateral esophageal wall thus preventing endoscopic removal without tearing the esophageal wall open. As the patient’s current state was degrading (descending pains and risk of mediastinitis), we considered another transfer to be an unfortunate choice, so we chose an open surgery approach. We opted for a lateral cervical esophagotomy. The surgery was performed under general anesthesia, and the retained foreign body was removed. The lateral wall of the esophagus was perforated and torn open vertically at the spot where the metal hook of the prosthesis lodged itself into the muscle wall. A 4‑centimeter incision circumscribed both parietal lesions and allowed the removal of the foreign body without any further damage. Postoperatively, a nasogastric feeding tube was maintained for 14 days. Ten days after the surgery a follow‑up CT-scan was performed. The imaging exam did not show any mediastinal or retromediastinal fluids. After the nasogastric feeding tube was removed the patient was gradually allowed back on solids without any complaints.