Incidence and Clinical Features of Esophageal Perforation Caused by Ingested Foreign Body

Ji Eun Kim; Seung Mok Ryoo; Youn-Jung Kim; Jong Seung Lee; Shin Ahn; Dong Woo Seo; Chang Hwan Sohn; Jeong-Min Ryu; Won Young Kim

doi:10.4166/kjg.2015.66.5.255

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Kim, Ryoo, Kim, Lee, Ahn, Seo, Sohn, Ryu, and Kim: Incidence and Clinical Features of Esophageal Perforation Caused by Ingested Foreign Body

Original Article

Korean J Gastroenterol 2015;66(5):255-260.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.66.5.255

Incidence and Clinical Features of Esophageal Perforation Caused by Ingested Foreign Body

Ji Eun Kim, Seung Mok Ryoo, Youn-Jung Kim, Jong Seung Lee, Shin Ahn, Dong Woo Seo, Chang Hwan Sohn, Jeong-Min Ryu, Won Young Kim

Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to: Won Young Kim, Department of Emergency Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3350, Fax: +82-2-3010-3360, E-mail: wonpia73@naver.com

Received 4 September 2015 Revised 8 October 2015 Accepted 10 October 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Esophageal perforation is a rare but often a life-threatening condition. However, the incidence and clinical features of esophageal perforation caused by ingested foreign body are unknown. This study investigated the incidence of esophageal perforation caused by ingested foreign body and evaluated the clinical features and outcome of patients with esophageal perforation.

Methods

Among a total of 196 adult patients with confirmed esophageal foreign body and complained of at least one of the related symptoms at the emergency department between January 2000 and July 2008, 18 patients with esophageal perforation due to esophageal foreign body ingestion were included in the study. Data were collected by retrospectively reviewing the electric medical records.

Results

The incidence of esophageal foreign body and esophageal perforation in adults was 19.4% (196/1,009) and 1.8% (18/1,009), respectively. Chest pain was the most common symptom and fishbone was the most common foreign body causing esophageal perforation. Mediastinitis or mediastinal abscess occurred in 13 patients (13/18, 72.2%). About half (8/18) of the patients were admitted to the intensive care unit but there was no in-hospital mortality.

Conclusions

The incidence of esophageal perforation in patients with foreign body ingestion was low but it increased up to 9.2% in patients with esophageal foreign body. However, prognosis was favorable with timely proper treatment. Chest pain can be an ominous sign indicating the presence of esophageal perforation in patients with esophageal foreign body.

Keywords: Esophageal perforation, Foreign bodies, Chest pain

References

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Fig. 1.

Categorization of patients with foreign body ingestion.

Table 1.

Clinical Characteristics of Patients with Esophageal Perforation

Characteristic	Value
Age (yr)	56.2±5.4
Sex
Male	13 (72.2)
Female	5 (27.8)
Symptoms
Chest pain	12 (66.7)
Neck pain	6 (33.3)
Foreign body sense in throat	5 (27.8)
Dyspnea	4 (22.2)
Odynophagia	4 (22.2)
Abdominal pain	4 (22.2)
Fever	3 (16.7)
Vomiting	1 (5.6)
Initial vital signs
Systolic blood pressure (mmHg)	141.0±19.6
Diastolic blood pressure (mmHg)	86.0±17.3
Pulse rate (rate/min)	91.6±15.6
Respiratory rate (rate/min)	21.1±3.5
Body temperature (^o C)	36.9±0.9
Symptom onset to ED (hr)	24 (12–84)
ED visit to remove (hr)	12 (0–24)
Combined complication
Mediastinitis	13 (72.2)
Abscess	6 (33.3)
Past history
Hypertension	5 (27.8)
Diabetes	3 (16.7)
Aortic valve replacement	1 (5.6)
Kidney transplantation	1 (5.6)
Angina pectoris	1 (5.6)

Values are presented as mean ± standard deviation, median (interquartile range), or n (%).

ED, emergency department.

Table 2.

Characteristics of Foreign Body

Characteristic	Value
Type
Fish bone	13 (72.2)
Animal bone (cow bone)	3 (16.6)
Crab shell	1 (5.6)
Wire	1 (5.6)
Successful removal	14 (77.8)
Impacted location (cm from upper incisor)	22.1±8.3
Size (mm)	29.6±24.6

Values are presented as n (%) or mean±standard deviation.

Table 3.

Result of Esophageal Perforation

Result	Value
Treatment
Surgery	8 (44.4)
Conservative treatment	10 (55.6)
Delayed complication	3 (16.7)
Length of hospital stay (day)	11 (6–27)

Values are presented as n (%) or median (interquartile range).

Table 4.

Summary of Eighteen Patients with Esophageal Perforation

No	Sex	Age (yr)	Associated complication	Cause	Past history	Location of symptoms	Treatment	Length of hospital stay (day)	Delayed complication
1	M	57	No	Fish bone	No record	Neck	Conservative	4	No
2	F	60	No	Fish bone	None	Neck	Conservative	5	No
3	M	48	No	Wire	None	Chest, abdomen	Conservative	11	No
4	M	54	No	Fish bone	HTN	Chest	Conservative	15	No
5	F	55	Mediastinitis	Fish bone	HTN, DM	Neck	Conservative	9	No
6	M	54	Mediastinitis	Fish bone	None	Chest	Conservative	8	No
7	M	66	Mediastinitis	Fish bone	DM	Chest	Conservative	Transferred	No records
8	M	58	Mediastinitis	Fish bone	HTN	Chest	Conservative	19	No
9	F	46	Mediastinitis	Fish bone	None	Chest	Primary closure, drainage	9	No
10	M	51	Mediastinitis	Fish bone	None	Chest	Esophageal resection & colon interposition	5	Esophageal stricture
11	F	52	Mediastinitis	Cow bone	None	Neck	Conservative	3	No
12	M	53	Abscess	Fish bone	Kidney transplantation	Neck, abdomen	Neck I&D (1st), open thoracotomy (2nd)	21	No
13	M	65	Abscess	Fish bone	None	Neck, chest	Empyectomy	39	No
14	F	53	Abscess	Fish bone	None	Chest	Thoracoscopic drainage	33	No
15	M	60	Abscess	Fish bone	HTN, DM, angina pectoris	Dyspnea (no pain)	I&D	84	Sepsis
16	M	57	Abscess	Chicken bone	None	Chest	Primary closure, drainage	70	ARDS
17	M	60	Abscess	Crab shell	HTN	Chest	I&D	12	No
18	M	62	No	Chicken bone	AVR	Chest	Conservative	7	No

HTN, hypertension; DM, diabetes mellitus; AVR, aortic valve replacement; I&D, incision and drainage; ARDS, adult respiratory distress syndrome.

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