Medicine of the Future in America

Esophageal foreign body causing direct aortic injury: DISCUSSION (Part 3)

The role of CT in foreign body esophageal perforation has been documented. A retrospective study of the CT scans of 12 patients with esophageal perforation revealed that extraluminal air was the most useful finding. The evaluated features, however, are not pathognomonic for esophageal perforation. The role of CT is not to confirm a highly suspicious case of esophageal perforation due to a foreign body but to provide further evidence in atypical cases. In the case presented, the fish bone was easily seen and the surrounding hematoma confirmed the observation that vascular injury was likely.

Nonoperative treatment of esophageal perforation without vascular injury may result in complications such as mediastinitis. Definitive treatment is controversial and some have advocated conservative treatment, even in cases of mediastinitis. Novel endoscopic treatments have been attempted, including endoscopic clipping of esophageal perforations. Some selective cases have resolved in a nonoperative approach but if there is a question of vascular injury, as with this case, operative management is the best choice. If you want to make your online shopping advantageous and safe, check out the best pharmacy to buy Cheap Asthma Inhalers Online without any need for a prescription, any time of the day or night with straight to the doorstep delivery.

The above case illustrates the importance of a detailed history, physical examination and timely investigations when dealing with a foreign body perforation of the esophagus resulting in vascular injury. In suspected esophageal perforation, CT scan remains the diagnostic modality of choice. If the CT scan does not show evidence of perforation but clinical suspicion remains high, the next diagnostic modality should be rigidesophagoscopy or surgery.

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