Although the bleeding seen on gastroscopy could have been a result of esophageal venous plexus injury, it is more likely that aortic injury had occurred. Bleeding from esophageal perforation most commonly results in intramural hematomas, but focal thickening of the esophageal wall was not seen. There are no case reports of intramural esophageal bleeding resulting in mediastinal hematomas as was seen in this case.
Direct visualization by gastroscopy remains an important method in the diagnosis of esophageal foreign bodies. Many therapeutic gastroscopic manoeuvres are used to disimpact the esophagus. We suggest that flexible gastroscopy is contraindicated in a case of established esophageal perforation. Although few case studies exist on flexible gastroscopy in esophageal perforation with subsequent conservative management of mediastinitis, it is reasonable to suggest that air insufflation during this procedure would lead to further morbidity. Characteristics of the suspected foreign body (coins, fishbones, needles), duration of foreign body impaction, underlying esophageal disease and clinical presentation with complications are required to assess the probability of esophageal perforation. In the present case, there was no objective x-ray evidence that esophageal perforation had occurred before the endoscopy. However, we suggest that if there is radiological evidence, or if clinical suspicion remains high for esophageal perforation, rigid esophagoscopy or CT scanning should be performed. You are always offered finest quality Xopenex for Asthma at the pharmacy you can fully trust and enjoy being its customer. Why wouldn’t you, if it offers lowest prices in the industry and fast delivery that can be free for some orders?