EGS P24 Management of oesophageal denture impaction and complications - a case series

Abstract

Abstract Background Dentures are sometimes inadvertently ingested and can impact in the oesophagus. This can lead to complications such as mediastinitis, perforation and major vascular fistulae. In 1914, Chiari coined ‘aorto-oesophageal syndrome’ following foreign body ingestion. Usually diagnosed post-mortem, he described a triad of chest pain, haematemesis and cardiac arrest resulting from perforation and aortic fistula. Modern dentures are radiolucent, have complex configurations and commonly impact in the oesophagus at the level of the aortic arch. Early specialist intervention by experienced oesophago-gastric (OG) surgeons is crucial to the prognosis. We present our personal experience of managing oesophageal denture impaction and complications. Methods A retrospective review of electronic health records of the authors’ case series of patients with a diagnosis of oesophageal denture impaction over a 13-year period from 01/01/2010 to 31/12/2022 was performed. The inclusion criteria was adult patients with a clinical diagnosis of oesophageal denture/dental bridge impaction. Pathology and complications from impaction and mode of intervention was reviewed. Other outcome measures evaluated were treatment complications, length of stay and 90-day mortality. Results Seven patients (6 males) with median age 54 were reviewed. Dentures were impacted at or above the aortic arch in 6 patients. Attempted retrieval with ENT rigid scope in 3 caused migration of denture causing perforation. Attempted retrieval with flexible gastroscope was successful in 3 but led to opening up of a fistula in one. Five patients underwent surgical intervention (results summarised in tables 1 and 2). 90-day mortality was 0%. The median length of stay in the surgical intervention group was 30 days. Two patients who had aorto-oesophageal fistulae required additional input by cardiac surgery and vascular radiology teams. Conclusions This is a report of the authors’ experience of managing oesophageal denture impaction and it’s sequelae. A favourable 0% 90-day mortality rate despite complex presentations including aorto-oesophageal fistulae has been described. For patients presenting with haematemesis or prolonged history of denture impaction a triple phase CT scan should be performed prior to intervention. The variable complex configuration of dentures complicates their impaction or attempts at extraction. Attempts at extraction with a rigid endoscope can lead to oesophageal perforation. Successful management of these complex cases requires an effective multidisciplinary approach in a specialist OG surgery centre.