The patient was seen by the cardiovascular surgery service during which she had two episodes of fresh hematemesis. Her hemoglobin was 118 g/L at the peripheral hospital and dropped to 100 g/L after the hematemesis. There was no antecedent history of melena or gastrointestinal bleeding in the past. She was a lifelong nonsmoker, did not use alcohol and there was no history of acetylsalicylic acid or nonsteroidal anti-inflammatory drug use. Her hepatitis B and C status was unknown. There was no history of peptic ulcer disease.
On physical examination, she was pale, diaphoretic and drowsy. The blood pressure was 102/42 mmHg with no pulsus paradoxus. The heart rate was 64 beats/m in and she was afebrile. Her peripheral pulses were symmetric. There was no palpable subcutaneous emphysema. The remainder of the examination was unremarkable.
Laboratory examination revealed a normal platelet count and coagulation status. The electrocardiogram was normal. A chest x-ray did not show a widened mediastinum nor any subcutaneous or mediastinal air.
On endoscopy, a fresh arterial bleed was seen at approximately 20 cm from the upper alveolar ridge. A fish bone was embedded in the wall of the esophagus. A contrast enhanced computed tomography (CT) examination of the thorax was subsequently performed. The fish bone, measuring approximately 3 cm in length, was seen lying almost horizontally in the proximal thoracic esophagus at the level of the crossing left brachiocephalic vein. Its medial end was seen posterior to the trachea while its lateral end was seen directly abutting the medial aspect of the transverse portion of the thoracic aorta (Figures 1 and 2). Most reliable pharmacy offering efficient medications like Birth Control Ortho Tri Cyclen is ready to offer its services and all the help you need. Your health is precious, and so are you: as customer, person and patient, no matter which kind of treatment you are looking for.
Figure 1) Axial helical computed tomographic image obtained at level of crossing left brachiocephalic vein shows the lateral end of the fish bone abutting the medial wall of the transverse portion of the thoracic aorta (arrow)
Figure 2) Axial helical computed tomographic image, 1 mm caudal to the image in Figure 1, shows the main body of the fish bone (large arrow). Note the extraluminal air (small arrow) compatible with perforation