Cardiothoracic Surgery: Student/Resident Case Report Poster - Cardiac and Thoracic Surgery |

Crucifix Foreign Body in the Middle Third of Esophagus: A Case Report FREE TO VIEW

Julio Herrera-Zamora, MD; Francina Valezka Bolanos Morales, MD; Miguel Angel Mercado-Diaz, MD; Dagho Dominguez-Olguin, MD; Heriberto Medina-Franco, MD; Nazeer Ahmad, MD; Patricio Santillan-Doherty, MD
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National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):57A. doi:10.1016/j.chest.2016.08.064
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SESSION TITLE: Student/Resident Case Report Poster - Cardiac and Thoracic Surgery

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Esophageal foreign body ingestion is frequently seen in pediatric population, however they are not so uncommon in adults. The type of foreign bodies depends upon different factors. In adults, psychiatric disorders, mental delay and drug intoxication predispose them to ingest unusual objects.

CASE PRESENTATION: A 46-year-old male with history of smoking, consumption of a bottle of liquor every weekend, and cocaine and marijuana addiction since 8 months ago, presented to our office with complaints of dysphagia. A chest X-ray was taken, in which a a radiopaque dense image in the middle third of esophagus was found. Next step an endoscopy was performed observing a metallic foreign body 20 centimeter below the upper dental arch embedded in the mucous of esophagus, it was impossible to remove it with this procedure. A CT-Scan was performed observing a dense metallic “T” image of 5.3×3.2 cm in front of T1, T2 and T3 vertebral body. The patient underwent surgery, cervical esophagus was located and pretracheal fascia was bluntly dissected till carina, a 2 cm myotomy was performed on thoracic portion of esophagus by pulling it to the cervical region; where foreing body was found and then a forester clip was introduced to extract the foreign body, esophagus was closed with gambee stitches and the muscular portion with monocryl 3/0 SH. Absence of leakage was checked haemostatic maneuvers were performed and Sengstaken-Blakemore 19Fr was placed. At the fifth day after the surgery a esophagogram was taken observing the small amount of lateral leakage, it was decided to start parentral nutrition. Five days later a follow up esophagogram was made, without evidence of leakage and the patient was discharged from hospital without any inflammatory response and with good oral tolerance.

DISCUSSION: The management of esophageal foreign body depends upon the type of material ingested. The surgical approach for removal of foreign body depends upon the anatomical localization, requiring cervical incisions for cervical esophageal foreign bodies, thoracic and abdominal access to remove foreign bodies that are found in middle third and inferior esophagus respectively.

CONCLUSIONS: The foreign body ingestion should be suspected in drug addicted individuals with unexplained aero-digestive symptoms and a careful history, thorough physical examination with proper chest X-ray can help to early diagnosis and management of foreign bodies

Reference #1: Celik S, Aydemir B,Tanrikulu H, Okay T, Dogusoy I. “Esophageal foreign bodies in children and adults:20 years experience”. Ulus Travma Acil Cerrahi Derg, 2013;19:229-34.

Reference #2: . A. Bane and A. Bekele, “Management of gastrointestinal foreign bodies using flexible endoscopy: an experience from Addis Ababa, Ethiopia” East Cent Afr J Surg, 2012;17(3).

Reference #3: Webb WA. MaWebb WA. Management of foreign bodies of the upper gastrointestinal tract: update. Gastrointest Endosc 1995;41:39-51.

DISCLOSURE: The following authors have nothing to disclose: Julio Herrera-Zamora, Francina Valezka Bolanos Morales, Miguel Angel Mercado-Diaz, Dagho Dominguez-Olguin, Heriberto Medina-Franco, Nazeer Ahmad, Patricio Santillan-Doherty

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