[Incidence and Clinical Features of Esophageal Perforation Caused by Ingested Foreign Body]

Diagnostic and Management Value of Multi-Slice Computed Tomography in Esophageal Jujube Pit Impaction

Objective: The diagnostic value of multi-slice computed tomography (MSCT) in esophageal jujube pit impaction was explored in this study. Methods: A retrospective analysis was performed on MSCT data obtained from a cohort of 40 patients experiencing esophageal jujube pit impaction. The study period encompassed the interval from December 2018 to November 2019. The analysis involved examining the age distribution of the patients, the location of the jujube pit impaction, its connection to the esophagus, associated complications, and the methods used for treatment. All imaging results were compared with the outcomes of surgical or endoscopic interventions. Results: (1) Out of 40 patients, 30 individuals were 58 years old or above, constituting 75% of the study sample. (2) In 80% of the instances (32 cases), the jujube pit was located in the initial segment of the esophagus, exhibiting a spindle shape with varying levels of central low density. (3) We examined the correlation between the angle of the impacted jujube pit and the esophageal longitudinal axis, categorizing 2 cases as longitudinal impaction, 16 as oblique impaction, and 22 as transverse impaction. Among the 40 cases, 28 displayed only slight thickening of the esophageal wall at the impaction site, while 9 cases exhibited heightened periesophageal fat density, and 3 showed small periesophageal air bubbles. (4) Endoscopic evaluation identified damage to the esophageal mucosa in 35 instances and the formation of esophageal perforation in 5 cases. Among patients with perforation, one or both ends of the jujube pit had penetrated the esophageal wall, accompanied by different levels of surrounding inflammatory encapsulation. Conclusion: MSCT is crucial for pinpointing jujube pit impaction and its relation to the esophageal wall and nearby structures, aiding in preoperative and postoperative complications. It is highly feasible for endoscopic cases but limited in complex ones needing thoracoscopy or open-heart surgery.

Feasibility and safety of a self-developed sleeve for the endoscopic removal of refractory foreign body incarceration

Objective

This study aimed to assess the feasibility and safety of a novel self-designed sleeve for the endoscopic removal of a refractory incarcerated foreign body in the upper gastrointestinal tract (UGIT).

Methods

An interventional study was conducted between June and December 2022. A total of 60 patients who underwent an endoscopic removal of a refractory incarcerated foreign body from the UGIT were randomly allocated to the self-developed sleeve and the conventional transparent cap. The study evaluated and compared the operation time, successful removal rate, new injury length at the entrance of the esophagus, new injury length at the impaction site, visual field clarity, and postoperative complications between the two groups.

Results

The success rates of the two cohorts in the foreign body removal display no significant discrepancy (100% vs. 93%, P = 0.529). Nevertheless, the methodology of the novel overtube-assisted endoscopic foreign body removal has culminated in a significant reduction in the removal duration [40 (10, 50) min vs. 80 (10, 90) min, P = 0.01], reduction in esophageal entrance traumas [0 (0, 0) mm vs. 4.0 (0, 6) mm, P < 0.001], mitigation of injuries at the location of the foreign body incarceration [0 (0, 2) mm vs. 6.0 (3, 8) mm, P < 0.001], an enhanced visual field (P < 0.001), and a decrement in postoperative mucosal bleeding (23% vs. 67%, P < 0.001). The self-developed sleeve effectively negated the advantages of incarceration exclusion during removal.

Conclusion

The study findings support the feasibility and safety of the self-developed sleeve for the endoscopic removal of a refractory incarcerated foreign body in the UGIT, with advantages over the conventional transparent cap.

Lesão transfixante de carótida por espinha de peixe - relato de caso

Accidental fish bone ingestion is a common complaint at emergency departments. The majority of cases have a benign course. However, serious complications such as esophagus perforation, cervical vessel injury and cervical abscess can occur in 7.4% of cases. Mortality rates can be as high as 50% when mediastinitis occurs. We report a case of an esophageal perforation caused by a fish bone with a lesion to the right common carotid artery after 20 days of evolution. Surgical exploration occurred with corrections of the lesion in the right common carotid and esophagus. Early identification of this kind of injury is paramount to prevent potentially fatal complications.

Carotid artery perforation by fish bone - a case report

Abstract Accidental fish bone ingestion is a common complaint at emergency departments. The majority of cases have a benign course. However, serious complications such as esophagus perforation, cervical vessel injury and cervical abscess can occur in 7.4% of cases. Mortality rates can be as high as 50% when mediastinitis occurs. We report a case of an esophageal perforation caused by a fish bone with a lesion to the right common carotid artery after 20 days of evolution. Surgical exploration occurred with corrections of the lesion in the right common carotid and esophagus. Early identification of this kind of injury is paramount to prevent potentially fatal complications.

Internal jugular vein thrombosis by sewing needle ingestion

Introduction

The internal jugular vein thrombosis is usually due to intravenous drug abuse, prolonged central venous catheterization or deep head-neck infections or trauma. Related malignancies, or inflammatory etiologies are described. Our case is interesting by the ingestion of a sewing needle that passes from the pharynx to the internal jugular vein via migration, leading to life-threatening complications: deep neck space infection and internal jugular vein thrombosis.

Case report

We report a case of a 40 years old patient, for acute cervical cellulitis in a context of odynophagia and fever, a CT scan revealed a jugular vein thrombosis, penetrated by a metal density foreign body. The diagnosis of ingested foreign body complicated by cervical cellulitis and thrombosis of the internal jugular vein was made. The patient underwent neck surgery with intravenous antibiotics. The postoperative course was uneventful, after one year of follow-up, no complications have been observed.

Discussion

no consensus has been reached concerning the management of postoperative and post traumatic vein thrombosis. Taking into account the risk of extension of the thrombus and the hemorrhagic risk each case should involve discussions among a multidisciplinary team.

Conclusion

The internal jugular vein thrombosis is a rare complication of ingested foreign bodies which may lead to life threat. The early diagnosis and adequate treatment of its life-threatening complications may result in excellent prognosis.

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No reported cases of internal jugular vein thrombosis caused by ingestion of a sewing needle.

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Association of two life threatening complications: deep neck space infection and internal jugular vein thrombosis

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Our objective was to bring attention to life threatening complications after foreign body ingestion.

Ligamentum arteriosum calcification that presented as an esophageal perforation caused by duck bone ingestion

Ligamentum arteriosum calcification is the calcification or ossification of arterial ligaments. However, on computed tomography images, ligamentum arteriosum calcification is often mistaken for esophageal perforation when a patient has a medical history of foreign body ingestion. Ligamentum arteriosum calcification is uncommon in clinical practice. In this case report, we confirm the presence of this condition intraoperatively, which has seldom been reported previously. Increased awareness of the clinical characteristics of this uncommon disease can help thoracic surgeons with proper patient management.

The removal of foreign body ingestion in the upper gastrointestinal tract: a retrospective study of 1,182 adult cases

Background

Foreign body (FB) ingestion in the gastrointestinal tract is a common and urgent problem observed in children and adults. However, there may be difficulty locating FBs and complications associated with their removal. This study aimed to identify risk factors and complications correlated to the presence and removal of FBs.

Methods

This 5-year retrospective study enrolled 1,311 patients between June 2014 and April 2019. Demographic and endoscopic data were collected, containing age, gender, types and location of FBs, duration of FB ingestion, accessory devices, endoscopic methods, and complications. Logistic regression analysis was applied to evaluate the predictive risk factors.

Results

Among 1,131 patients, FBs were found in 90.16% of cases. A major predictor for the presence of FB was a presentation of less than 24 hours (h). The types of FBs were jujube pits (36.72%) and fish bones (22.00%), and over 80% of the FBs were discovered in the esophagus. Complications were found in 239 cases (20.22%), of which hemorrhage (162/239, 67.78%) was the most frequent. Age ≥60, duration ≥24 h, and FBs ingested in the esophagus were considered as risk factors for developing complications.

Conclusions

In conclusion, the longer duration, age ≥60, and impaction in the esophagus were risk factors for developing complications following the ingestion of FBs. These factors should be considered when developing assessment and treatment plans in the management of FB ingestion.

Impacted dental bridge in the esophagus following general anesthesia: A case report

A dental bridge impacted in the esophagus of a 43-year-old man was successfully removed using endoscopy, without any further complications. It is of utmost importance that the medical staff carefully assess the patient's dental condition, provide clear documentation, and notify the patient appropriately to prevent dental prosthesis-related complications and claims. Anesthesiologists also need to be more cautious in the perioperative period, even after extubation, because this complication may not be completely avoidable.

Isolated Hemorrhagic Pericardial Effusion After Foreign Body Ingestion

Foreign body ingestion is one of the many potential causes of esophageal perforation. In this case report we describe a man who presented with chest pain and was found to have an isolated hemorrhagic pericardial effusion secondary to occult ingestion and pericardial migration of a metallic foreign body. Surgical management was successful, and the patient has recovered well.

Endoscopic Management of Foreign Bodies in the Gastrointestinal Tract: A Review of the Literature

Foreign body ingestion is a common diagnosis that presents in emergency departments throughout the world. Distinct foreign bodies predispose to particular locations of impaction in the gastrointestinal tract, commonly meat boluses in the esophagus above a preexisting esophageal stricture or ring in adults and coins in children. Several other groups are at high risk of foreign body impaction, mentally handicapped individuals or those with psychiatric illness, abusers of drugs or alcohol, and the geriatric population. Patients with foreign body ingestion typically present with odynophagia, dysphagia, sensation of having an object stuck, chest pain, and nausea/vomiting. The majority of foreign bodies pass through the digestive system spontaneously without causing any harm, symptoms, or necessitating any further intervention. A well-documented clinical history and thorough physical exam is critical in making the diagnosis, if additional modalities are needed, a CT scan and diagnostic endoscopy are generally the preferred modalities. Various tools can be used to remove foreign bodies, and endoscopic treatment is safe and effective if performed by a skilled endoscopist.

Oroesophageal Fish Bone Foreign Body

Fish bone foreign body (FFB) is the most frequent food-associated foreign body (FB) in adults, especially in Asia, versus meat in Western countries. The esophageal sphincter is the most common lodging site. Esophageal FB disease tends to occur more frequently in men than in women. The first diagnostic method is laryngoscopic examination. Because simple radiography of the neck has low sensitivity, if perforation or severe complications requiring surgery are expected, computed tomography should be used. The risk factors associated with poor prognosis are long time lapse after FB involvement, bone type, and longer FB (>3 cm). Bleeding and perforation are more common in FFB disease than in other FB diseases. Esophageal FB disease requires urgent treatment within 24 hours. However, FFB disease needs emergent treatment, preferably within 2 hours, and definitely within 6 hours. Esophageal FFB disease usually occurs at the physiological stricture of the esophagus. The aortic arch eminence is the second physiological stricture. If the FB penetrates the esophageal wall, a life-threatening aortoesophageal fistula can develop. Therefore, it is better to consult a thoracic surgeon prior to endoscopic removal.