A LATE-PRESENTING ESOPHAGEAL PERFORATION COMPLICATED BY ESOPHAGOMEDIASTINAL FISTULA
Main Article Content
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.
Article Details
Keywords
Esophageal perforation, fish bone, stent, mediastinal fistula, delayed diagnosis.
References
[2] Aiolfi A, Ferrari D, Riva C.G, Toti F, Bonitta G, Bonavina L. Esophageal foreign bodies in adults: systematic review of the literature. Scandinavian journal of gastroenterology, 2018, 53 (10-11): 1171-8. doi: 10.1080/00365521.2018.1526317
[3] Atilla E, İbrahim C.K et al. Esophageal perforation: the importance of early diagnosis and primary repair. Diseases of the Esophagus, 2004, 17 (1): 91-4. doi: 10.1111/j.1442-2050.2004.00382.x
[4] Kim H.U. Oroesophageal fish bone foreign body. Clinical Endoscopy, 2016, 49 (4): 318-326. doi: 10.5946/ce.2016.087
[5] Chirica M, Champault A, Dray X, Sulpice L, Munoz-Bongrand N, Sarfati E et al. Esophageal perforations. Journal of Visceral Surgery, 2010, 147 (3): e117-28.
[6] Wu J.T, Mattox K.L, Wall M.J. Esophageal perforations: new perspectives and treatment paradigms. The Journal of Trauma, 2007, 63 (5): 1173-84. doi: 10.1097/TA.0b013e31805c0dd4
[7] Biancari F, D’Andrea V, Paone R, Di Marco C, Savino G, Koivukangas V et al. Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies. World journal of surgery, 2013, 37 (5): 1051-9. doi: 10.1007/s00268-013-1951-7
[8] Altorjay A, Kiss J, Vörös A, Bohák A. Nonoperative management of esophageal perforations. Is it justified? Ann Surg, 1997, 225 (4): 415-21. doi: 10.1097/00000658-199704000-00011
[9] Vogel S.B, Rout W.R, Martin T.D, Abbitt P.L. Esophageal perforation in adults: aggressive, conservative treatment lowers morbidity and mortality. Ann Surg, 2005, 241 (6): 1016-23. doi: 10.1097/01.sla.0000164183.91898.74
[10] Freeman R.K, Ascioti A.J. Esophageal stent placement for the treatment of perforation, fistula, or anastomotic leak. Seminars in thoracic and cardiovascular surgery, 2011, 23 (2): 154-8. doi: 10.1053/j.semtcvs.2011.08.005
[11] Dasari B.V, Neely D, Kennedy A, Spence G, Rice P, Mackle E et al. The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations. Ann Surg, 2014, 259 (5): 852-60. doi: 10.1186/s13017-019-0245-2
[12] van Boeckel P.G, Sijbring A, Vleggaar F.P, Siersema P.D. Systematic review: temporary stent placement for benign rupture or anastomotic leak of the oesophagus. Alimentary pharmacology & therapeutics, 2011, 33 (12): 1292-301. doi: 10.1111/j.1365-2036.2011.04663.x
[13] Chirica M, Kelly M.D, Siboni S, Aiolfi A, Riva C.G, Asti E et al. Esophageal emergencies: WSES guidelines. World Journal of Emergency Surgery: WJES, 2019, 14: 26. doi: 10.1016/j.jviscsurg.2010.08.003