Esophageal Perforation and Mediastinitis
Esophageal Perforation and Mediastinitis
Esophageal perforation is a serious condition with a high mortality rate. Successful therapy depends on the size of the rupture, the time elapsed between rupture and diagnosis, and the underlying health of the patient. Common causes of esophageal perforation include medical instrumentation, foreign-body ingestion, and trauma. A case of esophageal perforation due to fish bone ingestion in a 70-year-old diabetic male is described here, with a review of the pertinent literature. The patient presented with odynophagia after a meal that included fish. Initial evaluation was nondiagnostic and the patient was discharged home. The patient returned 12 days later with fever, generalized weakness, and persistent dysphagia. Esophageal biopsy of a necrotic ulcer revealed foreign material with acute inflammatory changes. Computed tomography scan demonstrated a pneumomediastinum. The patient became hemodynamically unstable and died on the third hospital day.
The most common cause of esophageal perforation is iatrogenic. Typically, perforation occurs during endoscopy, with or without dilation. Spontaneous perforations and trauma are responsible for up to 20% of perforations. Although dysphagia is the main symptom when the esophagus is injured, dyspnea, epigastric pain, and signs of sepsis are also common. Location and size of the perforation, delayed diagnosis, and delay in initiating treatment are the main factors contributing to poor survival rates. We describe a patient with an esophageal perforation from a fish bone ingestion that resulted in mediastinitis.
Abstract
Esophageal perforation is a serious condition with a high mortality rate. Successful therapy depends on the size of the rupture, the time elapsed between rupture and diagnosis, and the underlying health of the patient. Common causes of esophageal perforation include medical instrumentation, foreign-body ingestion, and trauma. A case of esophageal perforation due to fish bone ingestion in a 70-year-old diabetic male is described here, with a review of the pertinent literature. The patient presented with odynophagia after a meal that included fish. Initial evaluation was nondiagnostic and the patient was discharged home. The patient returned 12 days later with fever, generalized weakness, and persistent dysphagia. Esophageal biopsy of a necrotic ulcer revealed foreign material with acute inflammatory changes. Computed tomography scan demonstrated a pneumomediastinum. The patient became hemodynamically unstable and died on the third hospital day.
Introduction
The most common cause of esophageal perforation is iatrogenic. Typically, perforation occurs during endoscopy, with or without dilation. Spontaneous perforations and trauma are responsible for up to 20% of perforations. Although dysphagia is the main symptom when the esophagus is injured, dyspnea, epigastric pain, and signs of sepsis are also common. Location and size of the perforation, delayed diagnosis, and delay in initiating treatment are the main factors contributing to poor survival rates. We describe a patient with an esophageal perforation from a fish bone ingestion that resulted in mediastinitis.
