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Industry: Email Alert RSS FeedEsophageal perforation and neck abscess from ingested foreign bodies: treatment and outcomes
Ear, Nose & Throat Journal, Oct, 2003 by Henry Chuen Kwong Lam, John Kong Sang Woo, Charles Andrew van Hasselt
Table 1. Summary of eight cases of esophageal perforation
Foreign Time to
Patient Sex/age body (FB) presentation
1 * F/74 Duck bone 4 days
2 ([dagger]) M/8 Chicken bone <24 hr
3 ([double dagger]) F/59 Fish bone <24 hr
4 ([double dagger]) F/36 Pork bone 2 days
5 ([dagger]) F/62 Fish bone <24 hr
6 ([dagger]) M/16 Beef bone <24 hr
7 * M/42 Pork bone <24 hr
8 ([double dagger]) F/21 Fish bone <24 hr
Patient Site of perforation Time of diagnosis
1 * Cervical esophagus During esophagoscopy
2 ([dagger]) Cervical esophagus <24 hr of FB ingestion
3 ([double dagger]) Lower thorax <48 hr following esoph-
agoscopy
4 ([double dagger]) Cervical esophagus -24 hr following eso-
phagoscopy
5 ([dagger]) Cervical esophagus <24 hr of FB ingestion
6 ([dagger]) Cervical esophagus <24 hr of FB ingestion
7 * Cervical esophagus During esophagoscopy
8 ([double dagger]) Cervical esophagus <24 hr following esoph-
agoscopy
Patient Clinical features Diagnosis confirmed by
1 * Postesophagoscopy Perforation noticed du-
fever, leukocytosis ring esophagoscopy
2 ([dagger]) Refusal to eat, fe- FB shadow, retropharyn-
ver, leukocytosis geal free gas on later-
al neck x-ray
3 ([double dagger]) Postesophagoscopy Esophageal-pleural fis-
chest pain, fever, tula on contrast
leukocytosis swallow
4 ([double dagger]) Postesophagoscopy Prevertebral soft-tis-
fever, leukocytosis sue swelling on lateral
neck x-ray; soft-tissue
swelling and retropha-
ryngeal free gas on CT
5 ([dagger]) Sore throat, fever, Retropharyngeal free gas
leukocytosis on lateral neck x-ray
6 ([dagger]) Upper chest pain, Retropharyngeal free gas
neck crepitus on lateral neck x-ray;
pneumomediastinum on
chest x-ray
7 * Postesophagoscopy Perforation noticed
sore throat, fever, during esophagoscopy
leukocytosis
8 ([double dagger]) Postesophagoscopy Leakage from cervical
fever, leukocytosis, esophagus on contrast
neck crepitus swallow exam
Patient Treatment Outcome
1 * IV antibiotics, Discharged home on
nasogastric tube day 9
feeding for 7 days
2 ([dagger]) IV antibiotics, Discharged home on
nasogastric tube day 12
feeding for 10 days
3 ([double dagger]) Bilateral chest Discharged home on
drain, IV antibio- day 28
tics, total parente-
ral nutrition for
21 days
4 ([double dagger]) Neck exploration, Admitted to intensive
right thoracotomy, care unit for 6 days;
left chest drain, IV discharged home on
antibiotics, naso- day 26
gastric tube feeding
for 13 days
5 ([dagger]) IV antibiotics, Discharged home on
nasogastric tube day 14
feeding for 11 days
6 ([dagger]) IV antibiotics, Discharged home on
nasogastric tube day 7
feeding for 5 days
7 * IV antibiotics, Discharged home on
nasogastric tube day 7
feeding for 6 days
8 ([double dagger]) IV antibiotics, Discharged home on
nasogastric tube day 23
feeding for 21 days
* Iatrogenic perforation diagnosed during esophagoscopy; ([dagger])
esophageal perforation diagnosed at presentation; ([double dagger])
iatrogenic perforation diagnosed after esophagoscopy.
Table 2. Summary of five cases of neck abscess
Foreign Time to
Patient Sex/age body (FB) presentation
4 * F/36 Pork bone 2 days
9 M/30 Fish bone 19 days
10 F/25 Fish bone 4 days
11 F/79 Pork bone 4 days
12 M/72 Fish bone 4 days
Patient Cause of abscess Clinical features
4 * latrogenic esopha- Fever, retrosternal
geal perforation pain, shortness of
breath, leukocytosis
9 FB Fever, sore throat,
odynophagia,
leukocytosis
10 FB Fever, sore throat,
leukocytosis
11 FB Fever, sore throat,
leukocytosis
12 FB Fever, odynophagia,
leukocytosis
Patient Radiologic findings Microbiology
4 * Soft-tissue swelling Group D streptococci
and retropharyngeal and Escherichia coli on
free gas on CT; pleural swab
bilateral pleural
effusions on chest
x-ray
9 Retropharyngeal No growth in pus from
swelling on lateral abscess
neck x-ray
10 Left parapharyngeal Hemolytic streptococci
and retropharyngeal and Streptococcus mill-
collection on neck eri in pus from absces
ultrasonography
11 Prevertebral air- No specimen obtained
fluid level at C5-C6
on lateral neck
x-ray
12 Retropharyngeal Klebsiella, Pseudomonas,
swelling on lateral and Peptostreptococus
pharyngeal abscess species in pus from
on CT abscess
Patient Treatment Outcome
4 * Neck exploration, Admitted to intensive
right thoracotomy, care unit for 6 days;
left chest drain, IV discharged home on day
antibiotics, naso- 26
gastric tube feeding
for 13 days
9 Rigid esophagoscopy, Discharged home on
internal drainage of day 8
retropharyngeal
abscess, IV antibio-
tics, nasogastric
tube feeding
10 Neck exploration, IV Discharged home on
antibiotics, naso- day 31
gastric tube feeding
11 IV antibiotics, na- Discharged home on
sogastric tube day 11
feeding (patient
refused surgery)
12 Neck exploration, Admitted to the inten-
intraoral drainage, sive care unit for 3
tracheostomy, IV days; discharged home
antibiotics, naso- on day 59 (the long
gastric tube feeding hospitalization was the
result of underlying
diabetes, concomitant
chest infection, and
the time required to
wean the patient off
his tracheostomy tube)
* Same patient as patient 4 in table 1.
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