Case Report
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 28, 2006; 12(44): 7213-7215
Published online Nov 28, 2006. doi: 10.3748/wjg.v12.i44.7213
Esophageal perforation caused by fish vertebra ingestion in a seven-month-old infant demanded surgical intervention: A case report
Ming-Yu Chang, Ming-Ling Chang, Chang-Teng Wu
Ming-Yu Chang, Division of Pediatric Critical Care and Emergency Medicine, Chang Gung Children’s Hospital, Taoyuan, Taiwan 333, China
Ming-Ling Chang, Department of Hepatogastroenterology, Chang Gung Memorial Hospital, Taoyuan, Taiwan 333, China
Chang-Teng Wu, Division of Pediatric Critical Care and Emergency Medicine, Chang Gung Children’s Hospital, Taoyuan, Taiwan 333; Chang Gung University, Taoyuan, Taiwan 333, China
Supported by grant from CGMH, Taoyuan, Taiwan, No. CMRPG 33014
Correspondence to: Chang-Teng Wu, Division of Pediatric Critical Care and Emergency Medicine, Chang Gung Children’s Hospital, No 5, Fu Hsing Street, Kuei Shan, Taoyuan, Taiwan, China. kitty8210@yahoo.com
Telephone: +886-3-3281200-8102 Fax: +886-3-3272236
Received: March 11, 2006
Revised: March 28, 2006
Accepted: April 30, 2006
Published online: November 28, 2006
Abstract

A seven-month-old infant was admitted to our hospital with a 1-wk history of shortness of breath, dysphagia, and fever. Diagnosis of esophageal perforation following fish vertebra ingestion was made by history review, pneumomediastinum and an irregular hyperdense lesion noted in initial chest radiogram. Neck computed tomo-graphy (CT) confirmed that the foreign body located at the cricopharyngeal level and a small esophageal tracheal fistula was shown by esophagogram. The initial response to treatment of fish bone removal guided by panendoscopy and antibiotics administration was poor since pneumothorax plus empyema developed. Fortunately, the patient’s condition finally improved after decortication, mediastinotomy and perforated esophagus repair. To our knowledge, this is the first case report of esophageal perforation due to fish bone ingestion in infancy. In addition to particular caution that has to be taken when feeding the innocent, young victim, it may indicate the importance of surgical intervention for complicated esophageal perforation in infancy.

Keywords: Fish bone; Esophageal perforation; Mediastinitis; Decortication; Mediastinotomy