Fatal Upper Esophageal Hemorrhage Caused by a Previously Ingested Chicken Bone

Abstract

Perforation of the upper esophageal wall by ingested bones can cause sudden death and death under suspicious circumstances. Perforation usually takes place at sites of physiologic and pathologic strictures. Temporary bleeding from the respiratory and digestive tracts is an important signal and may be crucial in the diagnosis of esophageal perforation and small vessel injury by ingested bone. Polymorphism and long symptomatology can cause diagnostic and therapeutic failure, thus presenting a special medicolegal problem. We present a case report of unknown cause of death and death under suspicious circumstances resulting from ingested bone perforation of upper esophagus. A chicken bone had been swallowed about 6 months before death caused by hemorrhage from a decubitus in the cervical esophagus. The patient underwent urgent surgery because of suspected bleeding of a ventricular ulcer.

Management of ingested foreign bodies in childhood and review of the literature

“…Foreign bodies impacted in the oropharynx are usually sharp,give rise to symptoms, and may cause life threatening complications such as retropharyngeal abscess and perforation [3,7,13,23]. Older patients with oropharyngeal foreign bodies are generally able to describe the location of the foreign body [13].…”

Management of ingested foreign bodies and food impactions

“…4,5 Mortality rates have been extremely low; a compilation of multiple studies including 2 large series report no deaths in 852 adults and 1 death in 2206 children. [6][7][8][9][10][11][12][13][14] The majority of foreign body ingestions occur in the pediatric population, with a peak incidence between the ages of 6 months and 6 years. 8,11,13,14 In adults, true foreign body ingestion (ie, nonfood objects) occurs more commonly in those with psychiatric disorders, developmental delay, alcohol intoxication, and in incarcerated individuals seeking secondary gain via release to a medical facility.…”

“…2,3,8 However, ingestion of sharp and pointed objects, animal or fish bones, bread bag clips, magnets, and medication blister packs increase the risk of perforation. 2,4,5,6,18,[22][23][24][25] …”

Esophageal foreign bodies: Types and techniques for removal

“…The esophagus is the most common location in the gastrointestinal tract for foreign body obstructions and accounts for 75% of all impactions [3]. The true incidence and overall mortality rate from ingested foreign objects are unknown, but deaths have been reported rarely [4,5]. The management of objects impacted in the esophagus is influenced by several key factors, including the type of object and its physical characteristics; location of the object; age of the patient and associated medical conditions; time elapsed since ingestion; and evidence of complications such as complete obstruction or perforation.…”