Articles Vol. 67 No. 6 25/06/2026

A LATE-PRESENTING ESOPHAGEAL PERFORATION COMPLICATED BY ESOPHAGOMEDIASTINAL FISTULA

Nguyen Quoc Thai1,2, Pham Huu Tung3,4, Tran Phung Dung Tien5,6
1 Department of Gastrointestinal Surgery, Tam Anh Hospital, Ho Chi Minh city
2 Khoa Ngoại Tiêu hóa, Bệnh viện Tâm Anh thành phố Hồ Chí Minh
3 Department of Endoscopy, Tam Anh Hospital, Ho Chi Minh city
4 Khoa Nội soi, Bệnh viện Tâm Anh thành phố Hồ Chí Minh
5 Department of Gastrointestinal Surgery, Cho Ray Hospital
6 Khoa Ngoại Tiêu hóa, Bệnh viện Chợ Rẫy
DOI: 10.52163/yhc.v67i6.5476
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Keywords
Esophageal perforation, fish bone, stent, mediastinal fistula, delayed diagnosis.
Abstract

Background: Esophageal perforation is a possibly life-threatening condition with mortality ranging from 10-40%. Delayed diagnosis, especially from fish bone ingestion, increases the risk of mediastinitis and chronic esophagomediastinal fistula.

Case presentation: A 28-year-old male experienced retrosternal pain after suspected fish bone ingestion and self-medicated without investigation. Symptoms subsided initially, but he developed chronic cough for 5 months after ingestion. Chest CT revealed a chronic esophagomediastinal fistula. The patient was treated with esophageal stenting. At 8 weeks follow-up, endoscopy confirmed complete healing of the fistula and the migrated stent-found in the stomach-was safely removed.

Conclusion: Delayed presentation of esophageal perforation may have an insidious course and is easily overlooked. Persistent respiratory symptoms in patients with a history of foreign body ingestion warrant imaging evaluation to rule out chronic fistula. Esophageal stent placement is an effective treatment option.

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