BACKGROUND Fishbone migration from the esophagus to the neck is relatively uncommon in clinical practice.Several complications secondary to esophageal perforation after ingestion of a fishbone have been described in t...BACKGROUND Fishbone migration from the esophagus to the neck is relatively uncommon in clinical practice.Several complications secondary to esophageal perforation after ingestion of a fishbone have been described in the literature.Typically,a fishbone is detected and diagnosed by imaging examination and is usually removed by a neck incision.CASE SUMMARY Herein,we report a case of a 76-year-old patient with a fishbone in the neck that had migrated from the esophagus and that was in close proximity to the common carotid artery,and the patient experienced dysphagia.An endoscopically-guided neck incision was made over the insertion point in the esophagus,but the surgery failed due to having a blurred image at the insertion site during the operation.After injection of normal saline laterally to the fishbone in the neck under ultrasound guidance,the purulent fluid outflowed to the piriform recess along the sinus tract.With endoscopic guidance,the position of the fish bone was precisely located along the direction of liquid outflow,the sinus tract was separated,and the fish bone was removed.To the best of our knowledge,this is the first case report describing bedside ultrasound-guided water injection positioning combined with endoscopy in the treatment of a cervical esophageal perforation with an abscess.CONCLUSION In conclusion,the fishbone could be located by the water injection method under the guidance of ultrasound and could be accurately located along the outflow direction of the purulent fluid of the sinus by the endoscope and was removed by incising the sinus.This method can be a nonoperative treatment option for foreign body-induced esophageal perforation.展开更多
Background:Esophageal injury is a common complication of foreign bodies in the upper gastrointestinal tract,but bilateral pleural effusion or vertebral infection is a rare condition due to a swallowed fishbone.It is c...Background:Esophageal injury is a common complication of foreign bodies in the upper gastrointestinal tract,but bilateral pleural effusion or vertebral infection is a rare condition due to a swallowed fishbone.It is considerably difficult for a physician to diagnose quickly because of incomplete patient history of foreign bodies ingestion and/or insufficient experiences.Patient concerns:We describe the case of a 56-year-old man who was admitted to an emergency medical department owing to a low to moderate fever for 7 days.After a series of examinations,the patient was diagnosed with esophageal perforation(EP)caused by a fishbone that was swallowed half a month ago.Diagnoses:About 12 days after the onset of fever,he was diagnosed with EP based on the gastric endoscopic images combined with histological section and sufficient history of the disease.About 2 months later,the patient has obvious back pain and lack of strength in two legs and was diagnosed with vertebral body infection.Interventions:Antibiotic therapy,multi-disciplinary team(MDT),and surgical intervention had been exerted.Outcomes:It is very fortunate for this patient to have a good prognosis due to a timely diagnosis and proper management.Muscle power has attained level 5.Lessons:Several lessons can be learned from this case;for example,physicians should be alerted to the EP,endoscopic intervention should be prompt,antibiotics should be used regularly,and so on.展开更多
Background:Nasogastric tube(NGT)placement is part of the post-operative management of upper gastrointestinal perforation,but its routine use in esophageal perforation(EP)caused by foreign bodies remains unclear.The pu...Background:Nasogastric tube(NGT)placement is part of the post-operative management of upper gastrointestinal perforation,but its routine use in esophageal perforation(EP)caused by foreign bodies remains unclear.The purpose of this research was to investigate the necessity for routine NGT placement in patients with EP after endoscopic foreign body removal.Methods:A total of 323 patients diagnosed with EP caused by foreign bodies at the First Affiliated Hospital of Nanchang University between January 2012 and December 2021 were included in this retrospective study.Patients were divided into the NGT group and the non-NGT group according to whether or not NGT placement was performed.The perforation healing rate,post-operative adverse events,hospital stay,and death rate were analysed using a 1:1 propensity score matching model.Results:Before matching,there were 263 patients in the NGT group and 60 patients in the non-NGT group.There were significant differences in the time to treatment,infection,albumin,and types of endoscopy between the two groups,while the length of hospital stay in the NGT group was significantly longer than that in the non-NGT group.After 1:1 propensity score matching,48 pairs of patients were matched between the two groups.The perforation healing rate,post-operative adverse events,length of hospital stay,and death rate did not show significant differences between the two groups.Conclusions:For patients with small EP caused by foreign bodies,routine NGT placement after endoscopic foreign body removal may be unnecessary.展开更多
In this report, a full account of an extremely rare case on esophageal intramural dissection （EID） is presented. A 56-year-old female patient, misdiagnosed as esophageal mediastinal fistula under endoscopic view, wa...In this report, a full account of an extremely rare case on esophageal intramural dissection （EID） is presented. A 56-year-old female patient, misdiagnosed as esophageal mediastinal fistula under endoscopic view, was diagnosed correctly as EID with contained esophageal perforation in the operation and cured by thoracic esophagectomy.展开更多
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 d...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.展开更多
BACKGROUND Massive upper gastrointestinal(GI)bleeding is usually urgent and severe,and is mostly caused by GI diseases.Aortoesophageal fistula(AEF)after thoracic aortic stent grafting is a rare cause of this condition...BACKGROUND Massive upper gastrointestinal(GI)bleeding is usually urgent and severe,and is mostly caused by GI diseases.Aortoesophageal fistula(AEF)after thoracic aortic stent grafting is a rare cause of this condition,and has a poor prognosis with a high mortality rate.The clinical symptoms of AEF are usually nonspecific,and the diagnosis is often difficult,especially when upper GI bleeding is absent.Early identification,early diagnosis,and early treatment are very important for improving prognosis.CASE SUMMARY A 74-year-old man was admitted to the infectious disease department with>10-d fever and 10-mo prior history of thoracic aortic stent grafting for thoracic aortic penetrating ulcers.Blood tests revealed elevated inflammatory indicators and anemia.Chest computed tomography(CT)showed postoperative changes of the aorta after endovascular stent graft implantation,pulmonary infection and pleural effusion.Pleural effusion tests showed empyema.After 1 wk of anti-infective treatment,temperature returned to normal and chest CT indicated improvement in pulmonary infection and reduction of pleural effusion.Esophageal endoscopy was performed because of epigastric discomfort,and showed a large ulcer with blood clot in the middle esophagus.However,on day 11,hematemesis and melena developed suddenly.Bleeding stopped temporarily after hemostatic treatment and bedside endoscopic hemostasis.Thoracic and abdominal aortic CT angiography confirmed AEF.Later that day,he suffered massive hemorrhage and hemorrhagic shock.Eventually,his family elected to discontinue treatment.CONCLUSION AEF should be strongly considered in patients with a history of aortic intervention who present with fever,especially with empyema.展开更多
There is no consensus on the appropriate therapeutic strategy for Boerhaave syndrome due to its rarity and changing therapeutic approaches.We conducted a systematic review of case reports documenting Boerhaave syndrom...There is no consensus on the appropriate therapeutic strategy for Boerhaave syndrome due to its rarity and changing therapeutic approaches.We conducted a systematic review of case reports documenting Boerhaave syndrome.AIM To assess the therapeutic methods and clinical outcomes and discuss the current trends in the management of Boerhaave syndrome.METHODS We searched PubMed,Google scholar,MEDLINE,and The Cochrane Library for studies concerning Boerhaave syndrome published between 2017 and 2022.RESULTS Of the included studies,49 were case reports,including a total of 56 cases.The mean age was 55.8±16 years old.Initial conservative treatment was performed in 25 cases,while operation was performed in 31 cases.The rate of conservative treatment was significantly higher than that of operation in cases of shock vital on admission(9.7%vs 44.0%;P=0.005).Seventeen out of 25 conservative cases(68.0%)were initially treated endoscopic esophageal stenting;2 of those 17 cases subsequently underwent operation due to poor infection control.Twelve cases developed postoperative leakage(38.7%),and 4 of those 12 cases underwent endoscopic esophageal stenting to stop the leakage.The length of the hospital stay was not significantly different between the conservative treatment and operation cases(operation vs conservation:33.52±22.69 vs 38.81±35.28 days;P=0.553).CONCLUSION In the treatment of Boerhaave syndrome,it is most important to diagnose the issue immediately.Primary repair with reinforcement is the gold-standard procedure.The indication of endoscopic esophageal stenting or endoluminal vacuum-assisted therapy should always be considered for patients in a poor general condition and who continue to have leakage after repair.展开更多
BACKGROUND Gastric pull-up(GPU)procedures may be complicated by leaks,fistulas,or stenoses.These complications are usually managed by endoscopy,but in extreme cases multidisciplinary management including reoperation m...BACKGROUND Gastric pull-up(GPU)procedures may be complicated by leaks,fistulas,or stenoses.These complications are usually managed by endoscopy,but in extreme cases multidisciplinary management including reoperation may be necessary.Here,we report a combined endoscopic and surgical approach to manage a failed secondary GPU procedure.CASE SUMMARY A 70-year-old male with treatment-refractory cervical esophagocutaneous fistula with stenotic remnant esophagus after secondary GPU was transferred to our tertiary hospital.Local and systemic infection originating from the infected fistula was resolved by endoscopy.Hence,elective esophageal reconstruction with freejejunal interposition was performed with no subsequent adverse events.CONCLUSION A multidisciplinary approach involving interventional endoscopists and surgeons successfully managed severe complications arising from a cervical esophagocutaneous fistula after GPU.Endoscopic treatment may have lowered the perioperative risk to promote primary wound healing after free-jejunal graft interposition.展开更多
BACKGROUND Esophageal foreign body(FB)is a common clinical emergency.Clinically,computed tomography(CT)scans are important in the diagnosis of FBs in the esophagus.Here,we report a case of esophageal perforation and c...BACKGROUND Esophageal foreign body(FB)is a common clinical emergency.Clinically,computed tomography(CT)scans are important in the diagnosis of FBs in the esophagus.Here,we report a case of esophageal perforation and cervical hematoma,caused by a FB,whose uniqueness made rapid diagnosis difficult.CASE SUMMARY A 42-year-old man was transferred to our hospital with esophageal perforation,which was accompanied by cervical and mediastinal hematoma.CT scans only revealed a black shadow,approximately 2.5 cm in diameter,in the upper esophagus.After multidisciplinary discussion,he was quickly subjected to mediastinal hematoma resection,peripheral nerve compression release,esophageal FB removal and esophagectomy.Eventually,we removed a small crab with a pointed tip from his esophagus.CONCLUSION This was an unusual case of occurrence of sharp polygonal esophageal FBs caused by a small crab.Rapid diagnosis of this FB was difficult,mainly due to its translucent nature.Occurrence of sharp FBs,with cavities that sometimes only appear as black shadows on CT scans,can easily be mistaken for esophageal lumens.More attention should be paid to such sharp polygonal FBs.展开更多
文摘BACKGROUND Fishbone migration from the esophagus to the neck is relatively uncommon in clinical practice.Several complications secondary to esophageal perforation after ingestion of a fishbone have been described in the literature.Typically,a fishbone is detected and diagnosed by imaging examination and is usually removed by a neck incision.CASE SUMMARY Herein,we report a case of a 76-year-old patient with a fishbone in the neck that had migrated from the esophagus and that was in close proximity to the common carotid artery,and the patient experienced dysphagia.An endoscopically-guided neck incision was made over the insertion point in the esophagus,but the surgery failed due to having a blurred image at the insertion site during the operation.After injection of normal saline laterally to the fishbone in the neck under ultrasound guidance,the purulent fluid outflowed to the piriform recess along the sinus tract.With endoscopic guidance,the position of the fish bone was precisely located along the direction of liquid outflow,the sinus tract was separated,and the fish bone was removed.To the best of our knowledge,this is the first case report describing bedside ultrasound-guided water injection positioning combined with endoscopy in the treatment of a cervical esophageal perforation with an abscess.CONCLUSION In conclusion,the fishbone could be located by the water injection method under the guidance of ultrasound and could be accurately located along the outflow direction of the purulent fluid of the sinus by the endoscope and was removed by incising the sinus.This method can be a nonoperative treatment option for foreign body-induced esophageal perforation.
文摘Background:Esophageal injury is a common complication of foreign bodies in the upper gastrointestinal tract,but bilateral pleural effusion or vertebral infection is a rare condition due to a swallowed fishbone.It is considerably difficult for a physician to diagnose quickly because of incomplete patient history of foreign bodies ingestion and/or insufficient experiences.Patient concerns:We describe the case of a 56-year-old man who was admitted to an emergency medical department owing to a low to moderate fever for 7 days.After a series of examinations,the patient was diagnosed with esophageal perforation(EP)caused by a fishbone that was swallowed half a month ago.Diagnoses:About 12 days after the onset of fever,he was diagnosed with EP based on the gastric endoscopic images combined with histological section and sufficient history of the disease.About 2 months later,the patient has obvious back pain and lack of strength in two legs and was diagnosed with vertebral body infection.Interventions:Antibiotic therapy,multi-disciplinary team(MDT),and surgical intervention had been exerted.Outcomes:It is very fortunate for this patient to have a good prognosis due to a timely diagnosis and proper management.Muscle power has attained level 5.Lessons:Several lessons can be learned from this case;for example,physicians should be alerted to the EP,endoscopic intervention should be prompt,antibiotics should be used regularly,and so on.
基金support provided by Jiangxi Clinical Research Center for Gastroenterology(20201ZDG02007).
文摘Background:Nasogastric tube(NGT)placement is part of the post-operative management of upper gastrointestinal perforation,but its routine use in esophageal perforation(EP)caused by foreign bodies remains unclear.The purpose of this research was to investigate the necessity for routine NGT placement in patients with EP after endoscopic foreign body removal.Methods:A total of 323 patients diagnosed with EP caused by foreign bodies at the First Affiliated Hospital of Nanchang University between January 2012 and December 2021 were included in this retrospective study.Patients were divided into the NGT group and the non-NGT group according to whether or not NGT placement was performed.The perforation healing rate,post-operative adverse events,hospital stay,and death rate were analysed using a 1:1 propensity score matching model.Results:Before matching,there were 263 patients in the NGT group and 60 patients in the non-NGT group.There were significant differences in the time to treatment,infection,albumin,and types of endoscopy between the two groups,while the length of hospital stay in the NGT group was significantly longer than that in the non-NGT group.After 1:1 propensity score matching,48 pairs of patients were matched between the two groups.The perforation healing rate,post-operative adverse events,length of hospital stay,and death rate did not show significant differences between the two groups.Conclusions:For patients with small EP caused by foreign bodies,routine NGT placement after endoscopic foreign body removal may be unnecessary.
文摘In this report, a full account of an extremely rare case on esophageal intramural dissection （EID） is presented. A 56-year-old female patient, misdiagnosed as esophageal mediastinal fistula under endoscopic view, was diagnosed correctly as EID with contained esophageal perforation in the operation and cured by thoracic esophagectomy.
文摘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.
文摘BACKGROUND Massive upper gastrointestinal(GI)bleeding is usually urgent and severe,and is mostly caused by GI diseases.Aortoesophageal fistula(AEF)after thoracic aortic stent grafting is a rare cause of this condition,and has a poor prognosis with a high mortality rate.The clinical symptoms of AEF are usually nonspecific,and the diagnosis is often difficult,especially when upper GI bleeding is absent.Early identification,early diagnosis,and early treatment are very important for improving prognosis.CASE SUMMARY A 74-year-old man was admitted to the infectious disease department with>10-d fever and 10-mo prior history of thoracic aortic stent grafting for thoracic aortic penetrating ulcers.Blood tests revealed elevated inflammatory indicators and anemia.Chest computed tomography(CT)showed postoperative changes of the aorta after endovascular stent graft implantation,pulmonary infection and pleural effusion.Pleural effusion tests showed empyema.After 1 wk of anti-infective treatment,temperature returned to normal and chest CT indicated improvement in pulmonary infection and reduction of pleural effusion.Esophageal endoscopy was performed because of epigastric discomfort,and showed a large ulcer with blood clot in the middle esophagus.However,on day 11,hematemesis and melena developed suddenly.Bleeding stopped temporarily after hemostatic treatment and bedside endoscopic hemostasis.Thoracic and abdominal aortic CT angiography confirmed AEF.Later that day,he suffered massive hemorrhage and hemorrhagic shock.Eventually,his family elected to discontinue treatment.CONCLUSION AEF should be strongly considered in patients with a history of aortic intervention who present with fever,especially with empyema.
文摘There is no consensus on the appropriate therapeutic strategy for Boerhaave syndrome due to its rarity and changing therapeutic approaches.We conducted a systematic review of case reports documenting Boerhaave syndrome.AIM To assess the therapeutic methods and clinical outcomes and discuss the current trends in the management of Boerhaave syndrome.METHODS We searched PubMed,Google scholar,MEDLINE,and The Cochrane Library for studies concerning Boerhaave syndrome published between 2017 and 2022.RESULTS Of the included studies,49 were case reports,including a total of 56 cases.The mean age was 55.8±16 years old.Initial conservative treatment was performed in 25 cases,while operation was performed in 31 cases.The rate of conservative treatment was significantly higher than that of operation in cases of shock vital on admission(9.7%vs 44.0%;P=0.005).Seventeen out of 25 conservative cases(68.0%)were initially treated endoscopic esophageal stenting;2 of those 17 cases subsequently underwent operation due to poor infection control.Twelve cases developed postoperative leakage(38.7%),and 4 of those 12 cases underwent endoscopic esophageal stenting to stop the leakage.The length of the hospital stay was not significantly different between the conservative treatment and operation cases(operation vs conservation:33.52±22.69 vs 38.81±35.28 days;P=0.553).CONCLUSION In the treatment of Boerhaave syndrome,it is most important to diagnose the issue immediately.Primary repair with reinforcement is the gold-standard procedure.The indication of endoscopic esophageal stenting or endoluminal vacuum-assisted therapy should always be considered for patients in a poor general condition and who continue to have leakage after repair.
文摘BACKGROUND Gastric pull-up(GPU)procedures may be complicated by leaks,fistulas,or stenoses.These complications are usually managed by endoscopy,but in extreme cases multidisciplinary management including reoperation may be necessary.Here,we report a combined endoscopic and surgical approach to manage a failed secondary GPU procedure.CASE SUMMARY A 70-year-old male with treatment-refractory cervical esophagocutaneous fistula with stenotic remnant esophagus after secondary GPU was transferred to our tertiary hospital.Local and systemic infection originating from the infected fistula was resolved by endoscopy.Hence,elective esophageal reconstruction with freejejunal interposition was performed with no subsequent adverse events.CONCLUSION A multidisciplinary approach involving interventional endoscopists and surgeons successfully managed severe complications arising from a cervical esophagocutaneous fistula after GPU.Endoscopic treatment may have lowered the perioperative risk to promote primary wound healing after free-jejunal graft interposition.
文摘BACKGROUND Esophageal foreign body(FB)is a common clinical emergency.Clinically,computed tomography(CT)scans are important in the diagnosis of FBs in the esophagus.Here,we report a case of esophageal perforation and cervical hematoma,caused by a FB,whose uniqueness made rapid diagnosis difficult.CASE SUMMARY A 42-year-old man was transferred to our hospital with esophageal perforation,which was accompanied by cervical and mediastinal hematoma.CT scans only revealed a black shadow,approximately 2.5 cm in diameter,in the upper esophagus.After multidisciplinary discussion,he was quickly subjected to mediastinal hematoma resection,peripheral nerve compression release,esophageal FB removal and esophagectomy.Eventually,we removed a small crab with a pointed tip from his esophagus.CONCLUSION This was an unusual case of occurrence of sharp polygonal esophageal FBs caused by a small crab.Rapid diagnosis of this FB was difficult,mainly due to its translucent nature.Occurrence of sharp FBs,with cavities that sometimes only appear as black shadows on CT scans,can easily be mistaken for esophageal lumens.More attention should be paid to such sharp polygonal FBs.
