Esophagus perforation and myocardial penetration caused by swallowing of a foreign body leading to a misdiagnosis of acute coronary syndrome: a case report

Abstract

IntroductionHere we present our clinical experience in a case of esophagus perforation due to the swallowing of a bone piece causing acute angina pectoris and leading to misdiagnosis of acute coronary syndrome.Case presentationA 73-year-old Caucasian man underwent urgent coronary angiography with possible diagnosis of acute coronary syndrome. His coronary arteries were found to be normal. A computed tomography examination revealed esophagus perforation by a foreign body (a piece of bone), and he underwent urgent left thoracotomy and the foreign body was removed.ConclusionsSometimes, even a piece of bone within a meal can lead to esophagus perforation, and injure the pericardium and myocardium. The symptoms of esophagus perforation may be confused with acute coronary syndrome due to their similarities and lack of knowledge about the detailed clinical history as shown in our case. Thus, careful consideration of detailed clinical history as well as choosing an appropriate medical imaging modality, such as computed tomography, should always be kept in mind in order to promptly diagnose and start early treatment to reduce mortality.

Isolated Hemorrhagic Pericardial Effusion After Foreign Body Ingestion

“…Cases of foreign body esophageal perforations leading to pericardial effusion, pericarditis, and even tamponade have been reported in the literature; each case, however, was accompanied by a pleural effusion that helped lead to the diagnosis [2,4,5]. Our patient is the first reported case, to our knowledge, of an isolated hemopericardium due to occult esophageal foreign body ingestion and perforation.…”

A Patient With a Zenker’s Diverticulum Showing Symptoms Similar to Acute Coronary Syndrome

“…Among diseases causing esophageal dysphagia, esophageal motility disorders resulting from hypercontractility or spasticity are reported to produce recurrent, angina-like and retrosternal chest pain of non-cardiac origin [10]. Furthermore, a case of esophageal perforation by a foreign body presenting with severe chest pain similar to ACS has also been reported [11]. Although the limitations of our report include our inability to perform endoscopic examination of the ZD on admission and a lack of follow-up information after discharge, deterioration of upper chest discomfort observed in our case on admission may associate with food residue temporarily stuck in the ZD because patient's symptoms got worse and persistent soon after swallowing a piece of sushi without chewing.…”

Surgical management of early and late esophageal perforation

“…Patients with spontaneous perforation, or Boerhaave syndrome, may not have typical manifestations, and treatment may be delayed. 5 Erdal and colleagues 6 treated a 73-year-old man with signs of acute coronary syndrome, in whom angiography was normal and chest computed tomography showed esophageal perforation. Shen and colleagues 7 reported a case of Boerhaave syndrome in a patient who presented 40 h after esophageal perforation in a state of septic shock.…”