Abstract
Abstract Background If a clinician encounters a foreign body in thoracic esophagus, flexible endoscopy is the first treatment modality that comes up in mind. But if the foreign body is too huge to pass the upper esophageal sphincter or stuck in esophageal wall, removal is not easy and could result in iatrogenic injury. Furthermore, esophageal perforation is clinically fatal situation and mandates prompt surgical intervention. Here, we report our successful single step treatment of esophageal perforation caused by huge foreign body. The procedure proceeded in operating room with endoscopic assistance. Methods Medical chart review. Results 69 years old male patient admitted to emergency department complaining of neck pain. About 4 days ago, he had ingested a crab. Since then, foreign body sensation and neck pain had been persisted. Computed Tomography (CT) and endoscopy revealed perforation of cervical esophagus. We performed a surgical exploration. With left cervical collar incision, we were able to exposure the injured esophagus. Simultaneously, a gastroenterologist performed an endoscopic inspection. Foreign bodies had migrated to the thoracic esophagus. With endoscopic forceps, most of foreign bodies were removed through the patient's mouth (including the longest one, about 4centimeter; cm). But, 2.8cm sized foreign body was not able to pass the upper esophageal sphincter. Thus, the gastroenterologist pulled the foreign body to level of perforated esophagus and we removed it without difficulty. Finally, the gastroenterologist checked the total length of esophagus. There was no other perforation. Then, we did primary repair of esophagus. The patient discharged at post operation day 11 without complication. Conclusion In our case, some of foreign body was situated perpendicularly in thoracic esophagus. Therefore, it couldn’t pass the upper esophageal sphincter, which the longer one could. With endoscopic assistance in operating room, single step treatment (foreign body removal and perforation repair) was possible. In addition, full inspection of total length of esophagus was possible, simultaneously. We think this single step approach is feasible in terms of avoiding unnecessary thoracic approach and multistep procedures (endoscopy followed by surgery). Disclosure All authors have declared no conflicts of interest.
Published Version
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