Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2022; 10(8): 2484-2490
Published online Mar 16, 2022. doi: 10.12998/wjcc.v10.i8.2484
Endoscopic extraction of a submucosal esophageal foreign body piercing into the thoracic aorta: A case report
Zhi-Cao Chen, Gui-Quan Chen, Xiao-Chun Chen, Chang-Ye Zheng, Wei-Dong Cao, Gang-Hao Deng
Zhi-Cao Chen, Gui-Quan Chen, Xiao-Chun Chen, Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
Chang-Ye Zheng, Department of Radiology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
Wei-Dong Cao, Gang-Hao Deng, Department of Cardiovascular Surgery, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
Author contributions: Chen GQ designed the report and performed the endoscopic surgery; Chen XC collected the patient’s clinical data; Chen ZC analyzed the data and wrote the paper; Zheng CY performed the CT imaging analysis; Cao WD and Deng GH performed the TEVAR surgery.
Informed consent statement: Informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gui-Quan Chen, MD, Chief Doctor, Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University, No. 78 Wandao Road, Wanjiang District, Dongguan 523000, Guangdong Province, China. chen_gui_quan@126.com
Received: September 25, 2021
Peer-review started: September 25, 2021
First decision: October 18, 2021
Revised: November 17, 2021
Accepted: January 27, 2022
Article in press: January 27, 2022
Published online: March 16, 2022
Processing time: 166 Days and 15.5 Hours
Abstract
BACKGROUND

Aorto-esophageal injury is a rare but life-threatening complication of esophageal foreign bodies, which typically requires open surgery. The best way to treat patients with this condition remains unclear. To date, few reports have described an aortic wall directly penetrated by a sharp foreign body. Here, we present a rare case of a fishbone completely embedded in the esophageal muscularis propria and directly piercing the aorta, which was successfully treated by endoscopy and thoracic endovascular aortic repair (TEVAR).

CASE SUMMARY

We report the case of a 71-year-old man with a 1-d history of retrosternal pain after eating fish. No abnormal findings were observed by the emergency esophagoscopy. Computed tomography showed a fishbone that had completely pierced through the esophageal mucosa and into the aorta. The patient refused to undergo surgery for personal reasons and was discharged. Five days after the onset of illness, he was readmitted to our hospital. Endoscopy examination showed a nodule with a smooth surface in the middle of the esophagus. Endoscopic ultrasonography confirmed a fishbone under the nodule. After performing TEVAR, we incised the esophageal mucosa under an endoscope and successfully removed the fishbone. The patient has remained in good condition for 1 year.

CONCLUSION

Incising the esophageal wall under endoscope and extracting a foreign body after TEVAR may be a feasible option for cases such as ours.

Keywords: Endoscopy; Esophageal foreign body; Esophageal perforation; Aortic penetration; Case report

Core Tip: Aorto-esophageal injury is a rare but life-threatening complication of esophageal foreign bodies, which typically requires open surgery. The best way to treat patients with this condition remains unclear. To date, few reports have described an aortic wall directly penetrated by a sharp foreign body. Here, we present a rare case of a fishbone completely embedded in the esophageal muscularis propria and directly piercing the aorta, which was successfully treated by endoscopy and thoracic endovascular aortic repair.