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Fulltext Posterior mediastinal abscess secondary to esophageal perforation following fish bone ingestion

Ahmad R, Ishlah W, Shaharudin MH, Sathananthar KS, Norie A

Med J Malaysia, 2008 Jun;63(2):162-3.
PMID: 18942310 MyJurnal

Accidental swallowing of fish bone, which arrested in esophagus, is fairly common. However the incidence of esophageal perforation due to fish bone swallowing is low. Delayed posterior mediastinal abscess as a result of the esophageal perforation is a rare manifestation and may lead to fatal outcome. Two cases of delayed formation of posterior mediastinal abscess following esophageal perforation due to accidental fish bone ingestion are described here. In these cases patients presented with interscapular back pain. In one of the cases the patient died because of the presentation was misdiagnosed hence leading to delay in the intervention. Radiological findings and surgical management namely esophagoscopy and neck exploration are briefly described.

Matched MeSH terms: Esophageal Perforation/etiology*
Fulltext Migrating foreign body--an unusual presentation

Krishnan G

Med J Malaysia, 1994 Jun;49(2):169-71.
PMID: 8090097

A case report of an ingested fish bone migrating to the subcutaneous tissue in the neck is presented. During its course of migration there was no significant morbidity. The usual management is to locate the foreign body and remove it. A review of the literature indicates that this is evidently a rare case.

Matched MeSH terms: Esophageal Perforation/etiology
Fulltext Repair of thoracic oesophageal perforation with latissimus dorsi flap

Yap CM

Med J Malaysia, 1994 Mar;49(1):100-1.
PMID: 8057981

Thoracic oesophageal perforation, a life-threatening condition, is a therapeutic challenge. A 20 year old male developed a lower oesophageal perforation following an abdominal cardiomyotomy for achalasia of the lower oesophagus. The resulting suppurative mediastinitis and left empyema thoracis were treated by decortication. The oesophageal perforation was closed using a transposition pedicle left latissimus dorsi muscle flap.

Matched MeSH terms: Esophageal Perforation/etiology; Esophageal Perforation/surgery*
Fulltext Screw Migration into Colon after Anterior Cervical Plating - An Unusual Complication: A Case Report

Sath S

Malays Orthop J, 2020 Nov;14(3):184-187.
PMID: 33403084 DOI: 10.5704/MOJ.2011.031

Complications in the form of esophageal injury, tracheal injury, injury to carotids, implant failure, loosening of screws, etc do occur after anterior cervical surgeries. Although intra-operative esophageal injuries are as such rare, there have been few reports of delayed esophageal perforation as well after anterior cervical surgeries. We report a very rare case of migration of missing screw from anterior cervical plate after anterior cervical corpectomy and plating, which had ultimately migrated down to colon and had to be removed via colonoscopy. Along with removal of migrated screw from colon, revision of failed anterior cervical surgery was done wherein plate and screws were removed with mesh cage left in-situ as it was snug-fit while pharyngeophageal perforation was explored and was found to be spontaneously healing, with addition of posterior Bohlman's interspinous wiring for added stability. Migration of screw from the anterior cervical plate into the colon although very rare, should be always kept in mind and its potentially serious complications. We also conclude that particular attention should be given to elderly people with poor bony quality who have high chances of implant failure, along with attention to proper cage size, screw position and proper locking of the screw to further lessen the chances of implant failure.

Matched MeSH terms: Esophageal Perforation
Fulltext A non-surgical management of delayed diagnosis of an oesophageal perforation due to ingestion of okra: a case report

Rosmadi Ismail, Ummi Affah Mahamad, Abdul Aziz Marwan

Malaysian Journal of Medicine and Health Sciences, 2020;16(108):87-89.
MyJurnal

Oesophageal perforation is a not uncommon condition, yet it carries a high mortality rate and has been observed as the most grievous trauma to the digestive tract. Common causes include iatrogenic instrumentation, foreign-body swallowing, and physical injury. This report highlighted a case of oesophageal perforation complicated by formation of proximal descending aorta pseudoaneurysm as a result of okra ingestion. The patient was successfully treated with conservative treatment. The possible mechanism of oesophageal rupture, diagnosis, treatment, and other complica- tion will be further discussed.

Matched MeSH terms: Esophageal Perforation
Perforation of oesophagus and aorta by an unusual migratory fish bone: case report

Alam AM, Shuaib IL, Hock LC, Bah EJ

Nepal Med Coll J, 2005 Dec;7(2):150-1.
PMID: 16519087

This report describes a migratory fish bone which was not found during 1st surgery causing perforation to the superior part of the arch of aorta. The patient presented with feeling of something stucked in her throat after eating fish subsequently followed by progressive excruciating pain in the neck. During 2nd surgery the fish bone was found to have migrated from the superior aspect of the arch of aorta to the anterolateral aspect of the arch of aorta after piercing the aortic lumen. We report a case of migratory fish bone which was not found during 1st surgery. The clinical examination of the throat revealed no foreign body. The CT scan of the neck and upper thorax demonstrated a 1cm linear foreign body part of which had perforated into the superior part of the arch of aorta with mediastinal hematoma. The most likely cause was a fish bone. The patient's condition slowly deteriorated, median sternotomy and exploration of mediastinum then followed. Unfortunately no fish bone was found and only mediastinal hematoma was discovered. After the first operation the patient condition did not improve and repeat CT scan of the neck and upper thorax was done 3 days later. A similar foreign body has now moved from the superior aspect of the arch of aorta to the anterolateral aspect of arch of aorta. Exploration was done again and this time the fish bone was found.

Matched MeSH terms: Esophageal Perforation*
Fulltext Oesophageal perforation following transoesophageal echocardiography: A case report on successful conservative management

Rosly NB, Loo GH, Shuhaili MAB, Rajan R, Ritza Kosai N

Int J Surg Case Rep, 2019;61:161-164.
PMID: 31374465 DOI: 10.1016/j.ijscr.2019.07.039

INTRODUCTION: Transoesophageal echocardiography (TOE) is a widely used intraoperative diagnostic tool in cardiac patients, and it is considered as a safe and non-invasive procedure. However, it has its known complications, which is estimated to be 0.18% with mortality reported as 0.0098%. Complications of TOE include odynophagia, upper gastrointestinal haemorrhage, endotracheal tube malpositioning and dental injury. One of the rarer complications includes oesophageal perforation, whose incidence is reported to be 0.01%.
CASE PRESENTATION: We present a case of a 61-year-old lady with mitral valve prolapse (MVP) who underwent TOE with subsequent presentation of odynophagia with left neck swelling. An upper endoscopy examination was inconclusive; however, a contrasted computed tomography of the neck showed evidence of cervical oesophageal perforation. She was managed conservatively and discharged well.
DISCUSSION: The trauma caused by TOE probe insertion and manipulation accounts for most of the upper gastrointestinal complications. Mortality of patients associated with oesophageal perforation can be up to 20% and doubled if the treatment is delayed for more than 24 h. Mechanism of injury from TOE probe is likely multifactorial. Predisposing factors that increase the risk of tissue disruption include the presence of unknown structural pathology. Imaging studies and an upper endoscopy examination may aid in the diagnosis of oesophageal perforation.
CONCLUSION: A high index of suspicion, coupled with a tailored, multidisciplinary approach, is essential to achieve the best possible outcome. Conservative management may be worthwhile in a stable patient despite delayed presentation. Although TOE is considered a safe procedure, physicians should be made aware of such a dreaded complication.

Matched MeSH terms: Esophageal Perforation
Fulltext Aorto-oesophageal fistula and aortic pseudoaneurysm caused by a swallowed fish bone

Sia KJ, Ashok GD, Ahmad FM, Kong CK

Hong Kong Med J, 2013 Dec;19(6):542-4.
PMID: 24310662 DOI: 10.12809/hkmj133668

We describe a rare case of aorto-oesophageal fistula and aortic pseudoaneurysm in a middle-aged man, who presented with chest pain and haematemesis 1 week after swallowing a fish bone. Oesophagogastroduodenoscopy and computed tomographic angiography findings were consistent with oesophageal perforation, proximal descending aortic pseudoaneurysm, and aorto-oesophageal fistula. Thoracic endovascular aortic repair was performed. The patient died from severe mediastinal sepsis. Early surgical intervention and broad-spectrum antibiotic therapy are crucial in preventing life-threatening mediastinal infection.

Matched MeSH terms: Esophageal Perforation/etiology; Esophageal Perforation/pathology
Fulltext Laparoscopic Heller myotomy and anterior Dor fundoplication for achalasia cardia in Malaysia: Clinical outcomes and satisfaction from four tertiary centers

Siow SL, Mahendran HA, Najmi WD, Lim SY, Hashimah AR, Voon K, et al.

Asian J Surg, 2021 Jan;44(1):158-163.
PMID: 32423838 DOI: 10.1016/j.asjsur.2020.04.007

BACKGROUND: To evaluate the clinical outcomes and satisfaction of patients following laparoscopic Heller myotomy for achalasia cardia in four tertiary centers.
METHODS: Fifty-five patients with achalasia cardia who underwent laparoscopic Heller myotomy between 2010 and 2019 were enrolled. The adverse events and clinical outcomes were analyzed. Overall patient satisfaction was also reviewed.
RESULTS: The mean operative time was 144.1 ± 38.33 min with no conversions to open surgery in this series. Intraoperative adverse events occurred in 7 (12.7%) patients including oesophageal mucosal perforation (n = 4), superficial liver injury (n = 1), minor bleeding from gastro-oesophageal fat pad (n = 1) & aspiration during induction requiring bronchoscopy (n = 1). Mean time to normal diet intake was 3.2 ± 2.20 days. Mean postoperative stay was 4.9 ± 4.30 days and majority of patients (n = 46; 83.6%) returned to normal daily activities within 2 weeks after surgery. The mean follow-up duration was 18.8 ± 13.56 months. Overall, clinical success (Eckardt ≤ 3) was achieved in all 55 (100%) patients, with significant improvements observed in all elements of the Eckardt score. Thirty-seven (67.3%) patients had complete resolution of dysphagia while the remaining 18 (32.7%) patients had some occasional dysphagia that was tolerable and did not require re-intervention. Nevertheless, all patients reported either very satisfied or satisfied and would recommend the procedure to another person.
CONCLUSIONS: Laparoscopic Heller myotomy and anterior Dor is both safe and effective as a definitive treatment for treating achalasia cardia. It does have a low rate of oesophageal perforation but overall has a high degree of patient satisfaction with minimal complications.

Matched MeSH terms: Esophageal Perforation/etiology; Esophageal Perforation/epidemiology
Fulltext Spontaneous oesophageal perforation: a case report

Shu Ann Hon, Jan Jan Chai, Lian Thai Lee, Qin Jian Low

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):326-328.
MyJurnal

A 49-year-old gentleman presented with epigastric pain for one day associated with one episode of vomiting and dyspnoea. Respiratory examination showed reduced breath sound over his left lower zone. He was treated as left spontaneous pneumothorax and left lung empyema requiring left chest tube insertion and intravenous antibiotics. His left pleural fluid biochemistry result was exudative while its centrifuge showed empyema. In ward, we noticed food material draining from his left chest tube during feeding. An urgent contrast enhanced computed tomography (CECT) thorax showed a left oesophageal-pleural fistula with possible broncho-oesophageal fistula. During oesoph- agogastroduodenoscopy (OGDS), air bubbles were seen in his left under-water chest drainage during air-insufflation of the oesophagus. The revised diagnosis was Boerhaave syndrome. He was treated with an esophageal stent to cover the perforation and a left lung decortication via video assisted thoracoscopic surgery (VATS) for his left empyema. He improved and was discharged well.

Matched MeSH terms: Esophageal Perforation