Medicine of the Future in America

Esophageal foreign body causing direct aortic injury: DISCUSSION (Part 1)

foreign body ingestionEsophageal perforation occurs in 1% to 4% of instances of foreign body ingestion. These complications carry a considerable morbidity from mediastinitis, paraesophageal abscess, pericarditis, pneumothorax, pyopneumothorax and pneumomediastinum. In a series of 511 cases of esophageal perforation, there is a reported mortality of 22%. Foreign body perforation was the etiology of 7% in that series. This condition, although uncommon, must be recognized in the appropriate clinical context.

Local inflammation results in erosion by the foreign body to adjacent structures. Areas of anatomic constriction have an increased risk of foreign body impaction and are common sites of perforation. The aorta is often involved and there are case reports of aortoesophageal fistulae developing over weeks to years. Aortoesophageal fistula is a diagnosis that is almost invariably fatal. Sloop and Thompson described the clinical features of this condition. A ‘signal hemorrhage’ precedes exsanguination, the timing of which is unpredictable. A fistulized tract through inflammatory tissues is thought to be the cause of the exsanguination, but the signal hemorrhage is thought to be due to local arterial bleeding. The current case was that of persistent pain and odynophagia for two days before the presentation of the signal hemorrhage. This demonstrates the extreme variability of the time course in vascular injury from foreign body esophageal perforation. A pharmacy you can fully trust is ready to offer best selection of cheap and effective medications that work the way they are expected to every time and are always available: you could buy cheap mircette and enjoy all the convenient services offered right now.

This entry was posted in Direct aortic injury and tagged Esophageal perforation, Foreign body, Hematemesis.
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