Published online Oct 21, 2014. doi: 10.3748/wjg.v20.i39.14510
Revised: May 15, 2014
Accepted: June 21, 2014
Published online: October 21, 2014
Foreign body ingestion is a common complaint in gastrointestinal clinics. It is usually not difficult to diagnose because most of the patients report a definitive history of accidental foreign body ingestion. However, in rare cases, patients do not have a clear history. Thus, the actual condition of the patient is difficult to diagnosis or is misdiagnosed; consequently, treatment is delayed or the wrong treatment is administered, respectively. This report describes a fatal case of esophageal perforation caused by an unknowingly ingested fishbone, which resulted in lower esophageal necrosis, chest cavity infection, posterior mediastinum fester, and significant upper gastrointestinal accumulation of blood. However, his clinical symptoms and imaging data are very similar with esophageal hiatal hernia. Unfortunately, because the patient was too late in consulting a physician, he finally died of chest infection and hemorrhage caused by thoracic aortic rupture. First, this case report underlines the importance of immediate consultation with a physician as soon as symptoms are experienced so as not to delay diagnosis and treatment, and thus avoid a fatal outcome. Second, diagnostic imaging should be performed in the early stage, without interference by clinical judgment. Third, when computed tomography reveals esophageal hiatus hernia with stomach incarceration, posterior mediastinal hematoma, and pneumatosis caused by esophageal, a foreign body should be suspected. Finally, medical professionals are responsible for making people aware of the danger of foreign body ingestion, especially among children, those who abuse alcohol, and those who wear dentures, particularly among the elderly, whose discriminability of foreign bodies is decreased, to avoid dire consequences.
Core tip: Foreign body ingestion is associated with a variety of symptoms and complications, including perforation of the esophagus, perforation of the aorta, embedment in the thyroid gland, and perforation of the carotid artery. However, gastrointestinal accumulation has been rarely reported. The clinical symptoms and imaging data of the patient in the current case report are very similar with esophageal hiatal hernia. In the present case, the patient unknowingly ingested a fishbone shaped similarly to a distorted toothpick. The migrating bone caused lower esophageal perforation and upper gastrointestinal accumulation, an unusual presentation after foreign body ingestion.