Management of Esophageal Perforation in a Sword Swallower: A Case Report and Review of the Literature

Management of sword-swallower injuries

Objective:

To report an unusual case of hypopharyngeal perforation in a sword-swallower, with emphasis on management options.

Method:

Case report and review of the English language literature concerning sword-swallowing injuries to the hypopharynx and oesophagus.

Results:

A 29-year-old male sword-swallower suffered hypopharyngeal perforation during a performance. The patient received conservative management, with intensive care unit admission, infectious disease consultation, intravenous antibiotics, discontinuation of oral intake and close observation. He progressed well, resumed oral intake on hospital day six, and was discharged home on hospital day eight.

Conclusion:

Sword-swallowing is an unusual vocation which may lead to potentially devastating injuries. This case report and review of the literature illustrates the management options for such hypopharyngeal and oesophageal injuries.

Sword swallowing and its side effects

OBJECTIVE

To evaluate information on the practice and associated ill effects of sword swallowing.

DESIGN

Letters sent to sword swallowers requesting information on technique and complications.

SETTING

Membership lists of the Sword Swallowers' Association International.

PARTICIPANTS

110 sword swallowers from 16 countries.

RESULTS

We had information from 46 sword swallowers. Major complications are more likely when the swallower is distracted or swallows multiple or unusual swords or when previous injury is present. Perforations mainly involve the oesophagus and usually have a good prognosis. Sore throats are common, particularly while the skill is being learnt or when performances are too frequent. Major gastrointestinal bleeding sometimes occurs, and occasional chest pains tend to be treated without medical advice. Sword swallowers without healthcare coverage expose themselves to financial as well as physical risk.

CONCLUSIONS

Sword swallowers run a higher risk of injury when they are distracted or adding embellishments to their performance, but injured performers have a better prognosis than patients who suffer iatrogenic perforation.