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Ehrsam JP, Meier Adamenko O, Schlumpf RB, Schöb OM. Foreign Glass Bodies in Pleura and Pancreas: Systematic Review for Entry Hypotheses and Treatment Options in an Unresolved Case. Surg Laparosc Endosc Percutan Tech 2024; 34:206-221. [PMID: 38450728 PMCID: PMC10986785 DOI: 10.1097/sle.0000000000001275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/19/2023] [Indexed: 03/08/2024]
Abstract
BACKGROUND Foreign bodies within the pleura and pancreas are infrequent, and the approaches to their treatment still a subject of debate. There is limited knowledge particularly regarding glass foreign bodies. METHODS We present a case involving large glass splinters in the pleura and pancreas, with an unknown entry point. In addition, a systematic review was conducted to explore entry hypotheses and management options. RESULTS In addition to our case, our review uncovered eight incidents of intrapleural glass, and another eight cases of glass in other intrathoracic areas. The fragments entered the body through impalement (81%), migrated through the diaphragm after impalement (6%), or caused transesophageal perforation (19%) following ingestion. Eight instances of glass inside the abdominal cavity were documented, with seven resulting from impalement injuries and one from transintestinal migration. There were no recorded instances of glass being discovered within the pancreas. Among the 41 nonglass intrapancreatic foreign bodies found, sewing needles (34%) and fish bones (46%) were the most common; following ingestion, they had migrated through either a transgastric or transduodenal perforation. In all these cases, how the foreign bodies were introduced was often poorly recalled by the patient. Many nonglass foreign bodies tend to become encapsulated by fibrous tissue, rendering them inert, though this is less common with glass. Glass has been reported to migrate through various tissues and cavities, sometimes with a significant delay spanning even decades. There are cases of intrapleural migration of glass causing hemothorax, pneumothorax, and heart and major blood vessels injury. For intrapleural glass fragment management, thoracoscopy proved to be effective in 5 reported cases, in addition to our patient. Most intrapancreatic nonglass foreign bodies tend to trigger pancreatitis and abscess formation, necessitating management ranging from laparoscopic procedures to subtotal pancreatectomy. There have been only four documented cases of intrapancreatic needles that remained asymptomatic with conservative management. There is no direct guidance from the existing literature regarding management of intrapancreatic glass foreign bodies. Consequently, our patient is under observation with regular follow-ups and has remained asymptomatic for the past 2 years. CONCLUSIONS Glass foreign bodies in the pleura are rare, and our report of an intrapancreatic glass fragment is the first of its kind. Impalement is the most likely method of introduction. As glass has significant migration and an ensuing complication potential, preventive removal of intrapleural loose glass should be considered. However, intrapancreatic glass fragment management remains uncertain.
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Wu DQ, Chen SY, Chen KG, Wang T, Li GY, Huang XS. Factors Influencing the Fasting Time in Adult Patients After the Endoscopic Management of Sharp Esophageal Foreign Bodies. Ther Clin Risk Manag 2024; 20:39-45. [PMID: 38344195 PMCID: PMC10854234 DOI: 10.2147/tcrm.s451517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/23/2024] [Indexed: 01/04/2025] Open
Abstract
BACKGROUND Sharp esophageal foreign body (SEFB) impaction can cause varying degrees of damage to the esophagus. There are few studies analyzing the postoperative fasting time in SEFB patients. METHODS We retrospectively collected 835 SEFB patients. According to the fasting time after the endoscopic removal (ER) of SEFBs, the patients were divided into two groups: short fasting time (SFT, fasted ≤24 h) and long fasting time (LFT, fasted >24 h). RESULTS There were 216 and 619 patients in the SFT and LFT group, respectively. The average age of the SFT group (52.97 years) was younger than that of the LFT group (55.96 years) (p = 0.025). The LFT group had lower proportion of duration of impaction (DOI) within 12 hours (14.2% vs 22.2%, p = 0.006) and erosion rates (89.0% vs 94.0%, p = 0.034) as well as higher proportion of esophageal perforation (19.5 vs 6.5%, p = 0.010) and patients who got intravenous anesthesia (63.78% vs 31.9%, p = 0.000) than the SFT group. The longest diameter of the foreign body (Lmax) in the LFT group (2.60 ± 1.01 cm) was greater than that in the SFT group (2.41 ± 0.83 cm; p = 0.01). Multivariate regression analysis found that age (OR = 1.726[1.208-2.465], p = 0.003), DOI (OR = 1.793[1.175-2.737], p = 0.007), Lmax (OR = 1.477[1.033-2.111], p = 0.032), perforation (OR = 3.698[2.038-6.710]; p < 0.01) and intravenous anesthesia (OR = 3.734[2.642-5.278]; p < 0.01) were the independent factors that prolonged fasting time in patients with SEFBs, while esophageal mucosal erosion (OR = 0.433[0.229-0.820]; p = 0.01) was the influencing factor leading to shortened fasting time. CONCLUSION For the first time, we analyzed factors influencing the fasting time after ER in SEFB patients. Age, DOI, Lmax, perforation and intravenous anesthesia were risk factors for a prolonged postoperative fasting time.
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Affiliation(s)
- Da-Quan Wu
- Otolaryngology Head and Neck Surgery, Zhongshan Hospital, Shanghai, 200032, People’s Republic of China
| | - Shu-Yang Chen
- Otolaryngology Head and Neck Surgery, Zhongshan Hospital, Shanghai, 200032, People’s Republic of China
| | - Ke-Guang Chen
- Otolaryngology Head and Neck Surgery, Zhongshan Hospital, Shanghai, 200032, People’s Republic of China
| | - Tan Wang
- Otolaryngology Head and Neck Surgery, Zhongshan Hospital, Shanghai, 200032, People’s Republic of China
| | - Guang-Yao Li
- Department of Otolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, 200031, People’s Republic of China
| | - Xin-Sheng Huang
- Otolaryngology Head and Neck Surgery, Zhongshan Hospital, Shanghai, 200032, People’s Republic of China
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Yang Q, Liu H, Shu X, Liu X. Risk factors for the poor prognosis of Benign esophageal perforation: 8-year experience. BMC Gastroenterol 2022; 22:537. [PMID: 36550403 PMCID: PMC9784251 DOI: 10.1186/s12876-022-02624-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Esophageal perforation (EP) has a high mortality rate and poor prognosis. This single-center retrospective study aims to analyze the related risk factors for benign EP. METHODS We retrospectively analyzed 135 patients with benign EP admitted to the First Affiliated Hospital of Nanchang University from January 2012 to December 2020. Univariate and multivariate logistic analysis were performed to estimate risk factors for prognosis of esophageal perforation patients. RESULTS There were 118 EP patients with foreign body ingestion and 17 patients with nonforeign body ingestion. Fish bones (78/118) were the most common foreign body and most of the nonforeign EPs were caused by spontaneous esophageal rupture (14/17). Foreign body perforations occurred mostly in the upper thoracic segment (70/118) and middle thoracic segment (31/118), and spontaneous esophageal ruptures occurred mostly in the lower thoracic segment (15/17). Fifteen patients (11.1%) died during hospitalization or within one month of discharge. Multivariable logistic regression analysis showed that high white blood cell (WBC) levels [odds ratio (OR) = 2.229, 95% confidential interval (CI): 0.776-6.403, P = 0.025], chest or mediastinal emphysema (OR = 7.609, 95% CI: 2.418-23.946, P = 0.001), and time to treatment > 72 h (OR = 3.407, 95% CI: 0.674-17.233, P = 0.018) were independent risk factors for poor prognosis. CONCLUSION Foreign body was the major reason for benign EP. High WBC level, chest or mediastinal emphysema and time to treatment > 72 h were risk factors for poor prognosis.
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Affiliation(s)
- Qinyu Yang
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haipeng Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Xu Shu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoming Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang, 330006, Jiangxi, China.
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Takise S, Nakajima M, Muroi H, Ihara K, Kubo T, Kikuchi M, Fujita J, Matsudera S, Inoue N, Yamaguchi T, Ogino K, Nakagawa M, Suzuki K, Morita S, Nakamura T, Kojima K. Successful combined laparoscopic and thoracoscopic surgery for esophago-mediastinal fistulae. Asian J Endosc Surg 2022; 16:293-296. [PMID: 36375812 DOI: 10.1111/ases.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/16/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
Minimally invasive surgeries have been developed, not only for gastrointestinal cancer, but also for benign or emergency cases. We report the case of a 62-year-old male who underwent laparoscopic and thoracoscopic combined surgery for an esophago-mediastinal fistula caused by a press-through package. In the initial laparoscopic phase, transhiatal dissection of the lower thoracic esophagus and harvesting of the greater omentum were performed. In the thoracoscopic phase, resection of the fistula and esophageal wall closure were performed. Thereafter, the greater omentum was lifted via the esophageal hiatus and wrapped around the repaired part of the esophagus for reinforcement. The total operative time was 371 min, with 163 and 208 min for the laparoscopic and thoracoscopic phases, respectively. In total, 20 ml of blood was lost. No perioperative complications or recurrences were observed. Laparoscopic and thoracoscopic combined omentoplasty was effective for refractory esophago-mediastinal fistula.
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Affiliation(s)
- Shuhei Takise
- Department of Upper Gastrointestinal of Surgery, Dokkyo Medical University, Tochigi, Japan.,Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, Tochigi, Japan
| | - Masanobu Nakajima
- Department of Upper Gastrointestinal of Surgery, Dokkyo Medical University, Tochigi, Japan.,Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, Tochigi, Japan
| | - Hiroto Muroi
- Department of Upper Gastrointestinal of Surgery, Dokkyo Medical University, Tochigi, Japan.,Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, Tochigi, Japan
| | - Keisuke Ihara
- Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, Tochigi, Japan
| | - Tsukasa Kubo
- Department of Upper Gastrointestinal of Surgery, Dokkyo Medical University, Tochigi, Japan.,Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, Tochigi, Japan
| | - Maiko Kikuchi
- Department of Upper Gastrointestinal of Surgery, Dokkyo Medical University, Tochigi, Japan.,Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, Tochigi, Japan
| | - Junki Fujita
- Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, Tochigi, Japan
| | - Shotaro Matsudera
- Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, Tochigi, Japan
| | - Noboru Inoue
- Department of Upper Gastrointestinal of Surgery, Dokkyo Medical University, Tochigi, Japan.,Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, Tochigi, Japan
| | - Takeshi Yamaguchi
- Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, Tochigi, Japan
| | - Kei Ogino
- Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, Tochigi, Japan
| | - Masatoshi Nakagawa
- Department of Upper Gastrointestinal of Surgery, Dokkyo Medical University, Tochigi, Japan.,Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, Tochigi, Japan
| | - Kan Suzuki
- Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, Tochigi, Japan
| | - Shinji Morita
- Department of Upper Gastrointestinal of Surgery, Dokkyo Medical University, Tochigi, Japan.,Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, Tochigi, Japan
| | - Takatoshi Nakamura
- Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, Tochigi, Japan
| | - Kazuyuki Kojima
- Department of Upper Gastrointestinal of Surgery, Dokkyo Medical University, Tochigi, Japan.,Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, Tochigi, Japan
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Hu K, Chen G, Hu D. Removal of an esophageal foreign body under real-time miniprobe endoscopic ultrasound guidance. Dig Endosc 2022; 34:e145-e146. [PMID: 35918306 DOI: 10.1111/den.14399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/04/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Kewei Hu
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Guilian Chen
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Duanmin Hu
- Department of Gastroenterology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Liao F, Zhu Z, Pan X, Li B, Zhu Y, Chen Y, Shu X. Safety and Efficacy of Nonoperative Treatment in Esophageal Perforation Caused by Foreign Bodies. Clin Transl Gastroenterol 2022; 13:e00451. [PMID: 35060929 PMCID: PMC8806378 DOI: 10.14309/ctg.0000000000000451] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/06/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Esophageal foreign bodies are often treated by endoscopy, but the treatment of esophageal perforation caused by foreign bodies remains controversial. The purpose of this study was to investigate the safety and efficacy of nonoperative treatment of esophageal perforation caused by foreign bodies. METHODS We retrospectively analyzed 270 patients admitted to our hospital for esophageal perforation caused by foreign bodies from January 2012 to December 2020, all of whom received nonoperative treatment. RESULTS The mean age of the patients was 56 ± 17 years, and fish bones were the most common type of foreign body. A total of 61.2% of the perforations were in the cervical esophagus. All patients received nonoperative treatment initially, and the foreign body removal rate using endoscopy reached 97%. The perforation healing rate reached 94.8%, whereas 3 patients (1.1%) died during hospitalization. The median (range) duration of hospitalization was 4 days (3-6). Multivariable analysis showed age ≥ 66 years (odds ratio [OR]: 2.196; 95% confidence interval [CI]: 1.232-3.916; P = 0.008), men (OR: 1.934; 95% CI: 1.152-3.246; P = 0.013), and time to treatment (OR: 1.126; 95% CI: 1.027-1.233; P = 0.011) were independent risk factors for infection, whereas the risk of infection was lower when the foreign body type was fish bone (OR: 0.557; 95% CI: 0.330-0.940; P = 0.028). DISCUSSION Nonoperative treatment is safe and effective for esophageal perforation caused by foreign bodies. Even if perforation is combined with infection, active nonoperative treatment can still achieve a good effect. Early intervention can effectively reduce the risk of infection and improve patient outcomes.
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Affiliation(s)
- Foqiang Liao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhenhua Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaolin Pan
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Bimin Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yin Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Youxiang Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xu Shu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Human Genetic Resources Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Song JT, Chang XH, Liu SS, Chen J, Liu MN, Wen JF, Hu Y, Xu J. Individualized endoscopic management strategy for impacting jujube pits in the upper gastrointestinal tract: a 3-year single-center experience in northern China. BMC Surg 2021; 21:18. [PMID: 33407359 PMCID: PMC7788756 DOI: 10.1186/s12893-020-01008-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background Impaction of jujube pits in the upper gastrointestinal (GI) tract is a special clinical condition in the northern Chinese population. Endoscopic removal is the preferred therapy, but there is no consensus on the management strategies. We reported our individualized endoscopic strategies on the jujube pits impacted in the upper GI tract. Methods In this retrospective study, we included 191 patients (male: 57; female: 134) who presented to our hospital with ingestion of jujube pits between January 2015 and December 2017. Demographic information, times of hospital visiting, locations of jujube pits, endoscopic procedures, post-extraction endoscopic characteristics were analyzed. Management strategies including sufficient suction, repeated irrigation, jejunal nutrition and gastrointestinal decompression were given based on post-extraction endoscopic characteristics and impacted locations. Results Peak incidence was in the second quarter of each year (85/191 cases, 44.5%). Among the 191 cases, 169 (88.5%) showed pits impaction in the esophagus, 20 (10.5%) in the prepyloric region and 2 (1.0%) in the duodenal bulb. A total of 185 patients (96.9%) had pits removed with alligator jaw forceps, and 6 (3.1%) underwent suction removal with transparent caps placed over the end of the endoscope to prevent injury on removal of these pits with two sharp painted edges. Post-extraction endoscopic manifestations included mucosal erosion (26.7%), mucosa laceration (24.6%), ulceration with a white coating (18.9%) and penetrating trauma with pus cavity formation (29.8%). All patients received individualized endoscopic and subsequent management strategies and showed good outcomes. Conclusions Individualized endoscopic management for impacted jujube pits in the upper GI tract based on post-extraction endoscopic characteristics and impacted locations was safe, effective, and minimally invasive.
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Affiliation(s)
- Ji-Tao Song
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xue-Fu Road, Nan-Gang District, Harbin, 150086, China
| | - Xiao-Hua Chang
- Department of Gastroenterology and Hepatology, The First Hospital of Harbin, Harbin, China
| | - Shan-Shan Liu
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xue-Fu Road, Nan-Gang District, Harbin, 150086, China.,Faculty of Health Service, Logistics University of Chinese People's Armed Police Force, Tianjin, China
| | - Jing Chen
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xue-Fu Road, Nan-Gang District, Harbin, 150086, China
| | - Ming-Na Liu
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xue-Fu Road, Nan-Gang District, Harbin, 150086, China
| | - Ji-Feng Wen
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xue-Fu Road, Nan-Gang District, Harbin, 150086, China
| | - Ying Hu
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xue-Fu Road, Nan-Gang District, Harbin, 150086, China
| | - Jun Xu
- Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xue-Fu Road, Nan-Gang District, Harbin, 150086, China.
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Pandit N, Yadav TN, Deo KB, Awale L, Jaiswal LS, Adhikary S. Foreign body-related oesophageal perforation: a case series at a community-based hospital in Nepal. Trop Doct 2020; 50:349-354. [PMID: 32638651 DOI: 10.1177/0049475520938171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Oesophageal perforation is rare, associated with diagnostic dilemma, delayed presentation and high mortality rate (36%). Early diagnosis and treatment are crucial for a good outcome. Treatment is by non-operative methods (antibiotics, drainage of collections, oesophageal stenting and nutritional support) or by surgery, depending on the condition of the patient, timing of presentation and expertise. During a five-year period (2015-2019), we managed seven cases of oesophageal perforation due to a foreign body. Of them, 4 (57%) received operative intervention, while 3 (43%) were managed non-operatively. One postoperative mortality ensued; there was a mean hospital stay of 20 days.
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Affiliation(s)
- Narendra Pandit
- Additional Professor, Surgical Gastroenterology Division, Department of Surgery, 58594BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Tek N Yadav
- Senior Resident, Surgical Gastroenterology Division, Department of Surgery, 58594BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Kunal B Deo
- Assistant Professor, Surgical Gastroenterology Division, Department of Surgery, 58594BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Laligen Awale
- Associate Professor, Surgical Gastroenterology Division, Department of Surgery, 58594BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Lokesh S Jaiswal
- Associate Professor, CTVS, Department of Surgery, 58594BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Shailesh Adhikary
- Professor, Surgical Gastroenterology Division, Department of Surgery, 58594BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
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Wang D, Gao CB. Rigid esophagoscopy combined with angle endoscopy for treatment of superior mediastinal foreign bodies penetrating into the esophagus caused by neck trauma: A case report. World J Clin Cases 2019; 7:4130-4136. [PMID: 31832418 PMCID: PMC6906559 DOI: 10.12998/wjcc.v7.i23.4130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Herein, we report a case in whom two foreign bodies entered the upper mediastinal cavity from the cervical root and subsequently the esophagus. Surgery is the preferred treatment method, and operational procedures depend on the size and location of the foreign body relative to the mediastinal vessels. Rigid esophagoscopy combined with angle endoscopic surgery was selected to avoid surgical trauma and complications.
CASE SUMMARY A 63-year-old male patient with a 6-mo old history of neck trauma presented with a black-brown foreign body in the lateral wall of the esophagus. Neck and chest computed tomography (CT) revealed that two superior mediastinal foreign bodies penetrated the esophagus diagonally. We removed two foreign bodies through an esophagoscope. Owing to the rigid working channel of esophagoscope and good exposure of endoscope, the risk of injury to the adjacent vital tissues was minimized. Postoperative comprehensive therapies, including antibiotic administration and nutritional support, resulted in a prompt postoperative recovery. Postoperative CT confirmed the absence of a residual foreign body and neck and chest infections. In addition, upper gastrointestinal angiography and gastroscopy revealed the absence of an evident esophageal perforation. The patient received an oral diet and did not experience any complication at the time of discharge from the hospital.
CONCLUSION Rigid esophagoscopy combined with angle endoscopy is an effective, minimally invasive treatment for penetrating neck injuries.
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Affiliation(s)
- Dong Wang
- Department of Otorhinolaryngology Head and Neck, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Chao-Bing Gao
- Department of Otorhinolaryngology Head and Neck, First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
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