Cervical esophagotomy for foreign body extraction - Case report and comprehensive review of the literature

Abstract

IntroductionEsophageal foreign bodies are an important and serious cause of morbidity and mortality in both children and adults. Due to the possibility of serious complications, i.e. perforation, necrosis, mediastinitis, and fistulation, rapid and accurate diagnostic measures with subsequent therapy are necessary.Case reportWe are reporting a case of a 55-year-old, mentally impaired patient that has swallowed a foreign body, which subsequently became lodged in his esophagus. Due to the fact that endoscopic removal was not possible and there was a high risk of complications such as esophageal perforation or mediastinitis in this case, we performed cervical esophagotomy and successfully extracted the foreign body. The patient showed an uneventful postoperative process and could be discharged on Day 11 after the operation.Comprehensive reviewFurthermore, we performed a systematic review of the literature to identify all studies that described a surgical approach through esophagotomy in cases of foreign body ingestion and found 11 publications describing the cases of 29 patients. These studies reported an overall complication rate of 17.2% and a mortality rate of 0%.ConclusionOur findings suggest that esophagotomy could be a viable approach for the extraction of foreign bodies especially in some cases when endoscopic removal was not successful and the risk of esophageal perforation is high.

Case report of uncommon esophageal foreign body: goat’s eye

“…A foreign body impacted in the esophagus requires immediate attention and early removal, because it may cause perforation, mediastinitis, and respiratory distress depending on the nature of the objects. 3,4 In this case, the foreign body could not cross the lower esophageal sphincter and had impacted in the esophagus causing dysphagia. Why the eye ball got trapped at expandable lower part is still unclear but the only possible explanation would be that the raw muscle, as well as the sphincter of the lower of esophagus must have swollen in transit, forcing the eye to become wedged.…”

Impacted Metallic Spring Requiring Cervical Esophagotomy: A Case Report and Review of the Literature on Foreign Body Removal

“…There are several types of endoscopic tools used to extract foreign bodies and the tool of choice depends on the characteristics of the foreign body. More commonly used tools include rat tooth forceps, alligator forceps, retrieval nets, protector hoods, and overtubes [ 6 , 7 ]. These last two tools are indicated in the removal of sharp objects.…”

“…In roughly 80% of cases of all foreign body ingestion, the object will pass spontaneously through the GI tract. However, in the remaining 20% of cases, retrieval of foreign bodies via esophagogastroduodenoscopy (EGD) is indicated in order to avoid serious complications, which can include perforation, necrosis, retropharyngeal abscess, mediastinitis, and fistulization [ 2 , 3 , 7 ]. Endoscopic removal of foreign bodies has a high success rate and low complication rates [ 5 , 8 ].…”

“…Endoscopic removal of foreign bodies has a high success rate and low complication rates [ 5 , 8 ]. However, when endoscopic removal is unsuccessful or contraindicated (as in our case), morbidity and mortality can be high [ 7 ]. In these rare instances (less than 1% of cases), surgery is indicated.…”

Airway Complications from an Esophageal Foreign Body

“…Studies have shown that 80–90% of all foreign bodies trapped in the esophagus pass spontaneously whereas the remaining 10–20% of cases will require an endoscopic intervention to remove the FBI [3]. …”