Abstract
We present a case of a 71-year-old woman who accidently swallowed a large fish bone that penetrated into the pulmonary vein. She visited the hospital the next day with a complaint of mild chest discomfort with slight pain and fever of 37.4 °C. Contrast-enhanced chest computed tomography (CT) scan revealed a large fish bone with a length of 35 mm impacted in the middle esophagus. The bone had penetrated into the pulmonary vein, causing mediastinitis. Blood tests revealed elevation in the white blood cell count and C-reactive protein level. Because intractable bleeding from pulmonary vein after endoscopic removal can be lethal, endoscopic removal of the fish bone in an operating room under general anesthesia with cardiovascular surgical standby for possible emergency surgery was selected. After endoscopic removal, mediastinal hematoma was absent with a follow-up chest CT scan, and the mediastinitis was treated with intravenous antibiotics. The patient shortly became afebrile with normalized blood test findings. After confirming the normal findings on the follow-up chest CT scan and endoscopic inspection in the next week, she was discharged from the hospital 10 days after hospitalization without any complications. When the swallowed bone penetrates into the major pericardial vessels, unprepared endoscopic removal may result in fatal sequelae such as intractable mediastinal hemorrhage. Urgent consultation with cardiovascular or thoracic surgeons for a possible emergent surgery is needed before endoscopic removal is attempted.
Highlights
A swallowed foreign body such as a fish bone usually passes through the esophagus spontaneously without the requirement of therapeutic removal [1]
We report a very rare case of an impacted esophageal large fish bone that penetrated into the pulmonary vein, causing mediastinitis
Endoscopic removal of the fish bone was performed in the operating room under general anesthesia (Figure 2C, D) with cardiovascular surgical standby for a possible urgent surgery with a right thoracotomy approach
Summary
A swallowed foreign body such as a fish bone usually passes through the esophagus spontaneously without the requirement of therapeutic removal [1]. An impacted intra-esophageal fish bone could result in severe and fatal consequences such as penetration or perforation without proper diagnosis followed by appropriate therapeutic interventions. We report a very rare case of an impacted esophageal large fish bone that penetrated into the pulmonary vein, causing mediastinitis. It was removed under general anesthesia in the operating room with a cardiovascular surgical standby
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