Esophageal perforation caused by a dental prosthesis

Abstract

An 83-year-old patient with dementia was admitted because of complaints of cervical discomfort, without respiratory symptoms, after what she described as having swallowed her dental prosthesis. There were no pathological findings in objective examination. The patient underwent thoracic radiography showing a radiopaque foreign body in the cervical region in a format compatible with the history provided (Figure 1) and (Figure 2). Endoscopic evaluation revealed that the more cephalic portion of the prosthesis was at the epiglottis level, with no possibility of endoscopic removal due to apparent resistance to mobilization. During the maneuvers to prepare intubation and protect the airway, the prosthesis was found mobile and was removed with a Magill forceps. After that procedure, on inspection with the laryngoscope, no lesions were found, and by that time we no longer had the possibility to perform an endoscopy. The same day cervicothoracic computed tomography described cervical and mediastinal subcutaneous emphysema (Figure 3). During surveillance, nil per os, antibiotic therapy and proton pump inhibitor were provided. Therapy with Piperacillin-Tazobactam and Vancomycin was chosen, but due to the worsening of the clinical condition, it was necessary to add antifungal therapy on the fifth postoperative day, although the revaluation computed tomography of this date did not reveal the existence of any collection. On the tenth postoperative day, an oral contrast study with gastrografin revealed no leakage and oral diet was resumed uneventfully.