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

Erdal U, Mehmet D, Turkay K, Mehmet IA, Ibrahim N, Hasan B - J Med Case Rep (2015)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery and Transplantation Center, Sanko University Hospital, Gaziantep, Turkey. drerdaluysal@hotmail.com.

ABSTRACT

Introduction: Here 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 presentation: A 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.

Conclusions: Sometimes, 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.

No MeSH data available.


Related in: MedlinePlus

Surgically removed bone fragment.
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Fig2: Surgically removed bone fragment.

Mentions: These findings revealed a perforation of esophagus by a foreign body, and the patient underwent urgent left thoracotomy. At surgery, a sharp contoured piece of bone was found, perforating the 1/3 distal aspect of the posterior wall of his esophagus. It reached to the pericardium, penetrating it and eroding his left atrium. The adventitia of the aorta was affected on the left. There was pus in his pericardium. The foreign body was removed (FigureĀ 2). After abundant serum irrigation, his esophagus was repaired by primary sutures, and pleura was attached on the defect side and supported by tissue adhesives. Finally, a percutaneous jejunostomy was performed for feeding by laparotomy. Parenteral broad spectrum antibiotic therapy and feeding from the jejunostomy was started. No postoperative complication was observed, and the patient was discharged from our hospital on the 15th day. After 3 days, he was readmitted and hospitalized again with the complaints of fever and weakness. Contrast extravasation from the primary suture zone was found in a CT examination, then he underwent endoscopic stent placement. His clinical condition deteriorated rapidly due to mediastinitis and he died because of sepsis and multiorgan failure.Figure 2


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

Erdal U, Mehmet D, Turkay K, Mehmet IA, Ibrahim N, Hasan B - J Med Case Rep (2015)

Surgically removed bone fragment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4363457&req=5

Fig2: Surgically removed bone fragment.
Mentions: These findings revealed a perforation of esophagus by a foreign body, and the patient underwent urgent left thoracotomy. At surgery, a sharp contoured piece of bone was found, perforating the 1/3 distal aspect of the posterior wall of his esophagus. It reached to the pericardium, penetrating it and eroding his left atrium. The adventitia of the aorta was affected on the left. There was pus in his pericardium. The foreign body was removed (FigureĀ 2). After abundant serum irrigation, his esophagus was repaired by primary sutures, and pleura was attached on the defect side and supported by tissue adhesives. Finally, a percutaneous jejunostomy was performed for feeding by laparotomy. Parenteral broad spectrum antibiotic therapy and feeding from the jejunostomy was started. No postoperative complication was observed, and the patient was discharged from our hospital on the 15th day. After 3 days, he was readmitted and hospitalized again with the complaints of fever and weakness. Contrast extravasation from the primary suture zone was found in a CT examination, then he underwent endoscopic stent placement. His clinical condition deteriorated rapidly due to mediastinitis and he died because of sepsis and multiorgan failure.Figure 2

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery and Transplantation Center, Sanko University Hospital, Gaziantep, Turkey. drerdaluysal@hotmail.com.

ABSTRACT

Introduction: Here 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 presentation: A 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.

Conclusions: Sometimes, 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.

No MeSH data available.


Related in: MedlinePlus