Total gastrectomy in an elderly patient complicated by esophageal fistula: rescue by the over-the-scope clip

Snapper fishbone esophageal perforation closed with an over-the-scope-clip

“…The OTSC has been used increasingly since 20071 as a safe and effective method for the closure of gastrointestinal wall defects,2 with few applications in the oesophagus being reported and most in the context of postsurgical management 3Learning points

The value of a detailed clinical history and to have a high degree of suspicion for a late manifestation of a perforation due to a fishbone.

Impaction of foreign bodies is usually at the cricopharingeal level (70%) and seldom at the lower oesophageal sphincter (10%).

Fishbone has a low calcium content which renders it hard to see on the roentgenogram.

Successful over-the-scope-clip usage for the (late) management of an oesophageal perforation in a septic octogenarian.

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