Vascular Injury following Foreign Body Perforation of the Esophagus

Abstract

Esophageal perforation resulting from foreign body ingestion is a rare occurrence. Most of the complications associated with this event, such as retroesophageal abscess, mediastinitis, pericarditis, pneumothorax, and pneumomediastinum, are widely recognized. However, little attention has been directed to the possibility of vascular injury caused by the perforating object. Isolated case reports have described significant morbidity and mortality subsequent to major vascular trauma resulting from an esophageal foreign body, usually emphasizing the presence of a "signal" hemorrhage from the gastrointestinal tract as a key to diagnosis. This report describes a case of esophageal perforation caused by an ingested fishbone that resulted in significant aerodigestive hemorrhage, possibly as the result of an unusual isolated vascular injury. The literature on vascular trauma following foreign body perforation of the esophagus is reviewed, and suggestions for the diagnosis and treatment of these dreaded complications are made.

Aorto-oesophageal fistula and aortic pseudoaneurysm caused by a swallowed fish bone

“…5 Perforation of the oesophagus with aortic fistulation is usually fatal. 6 Kelly et al 7 reviewed over 100 documented cases of aorto-oesophageal fistula secondary to foreign body ingestion, and noted that only seven had survived 12 months. Conservative treatment of aorto-oesophageal fistula results in a 60% in-hospital mortality rate and zero late survival, whereas conventional surgical treatment is reported to have an in-hospital mortality of nearly 40%.…”

Clinical Characteristics of an Esophageal Fish Bone Foreign Body fromChromis notata

“…Generally, esophageal perforation due to foreign body ingestion is rare and accounts for 1%-4% of the total reported cases (8). In one study, the pharyngeal location, fish bone, and radiolucency were associated with an increased incidence of complications in patients over 10 yr of age (9).…”

“…The fish bones have a sharp polygonal or pin-like pointed structure and they can perforate or tear the esophageal wall. It can cause pneumomediastinum, mediastinitis, pneumothorax (10), tracheoesophageal fistula (11), major vascular damage (8, 12), and so far as to systemic air embolism in rare case (13). Upper esophageal and oropharyngeal FBFB can cause soft tissue infection and other complications including fistula formation and carotid arterial injury (14, 15).…”

Vertebral artery dissection due to an esophageal foreign body migration

“…Esophageal wall penetration and migration of foreign bodies is uncommon. Its incidence is reported to be between 1% and 4% [1]. It could be a life threatening condition as the foreign body could cause serious cervical, mediastinal suppuration or vascular complications.…”