American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
Open Access
Journal Browser
Go
American Journal of Medical Case Reports. 2021, 9(1), 40-44
DOI: 10.12691/ajmcr-9-1-11
Open AccessCase Report

Chicken Bone Perforation “The Missing Link” in a Bemused Breathless Octogenarian-A Case Report of Endoscopic Revivification

Abhilash Haridas1, , Midhun Ramesh2, Padmavathy Ramadoss2 and Ravi Sreekumaran Nair2

1Sree Gokulam Medical College, and Sree Gokulam GG Hospital, Trivandrum, Kerala State, India

2SK Hospital, Trivandrum, Kerala State, India

Pub. Date: November 04, 2020

Cite this paper:
Abhilash Haridas, Midhun Ramesh, Padmavathy Ramadoss and Ravi Sreekumaran Nair. Chicken Bone Perforation “The Missing Link” in a Bemused Breathless Octogenarian-A Case Report of Endoscopic Revivification. American Journal of Medical Case Reports. 2021; 9(1):40-44. doi: 10.12691/ajmcr-9-1-11

Abstract

Esophageal perforation is a rare complication of foreign body ingestion. The most common foreign bodies causing esophageal perforation in adults are fish and chicken bones. We present the case of an octogenarian man with mild cognitive impairment presenting with respiratory complaints of dyspnoea and orthopnoea in the emergency room. He had hyponatremia induced confusion in addition to his mild cognitive impairment. The diagnosis for his clinical condition was not evident. Evaluation by imaging detected the "missing link" chicken bone as the cause of esophageal double perforation with mediastinitis and bilateral pleural effusion. Following multidisciplinary discussion, the minimally invasive endoscopic approach was decided as the definitive therapy. After medical stabilization in ICU, he underwent endoscopic retrieval of the foreign body followed by fully covered self-expandable metallic stenting. He recovered well and the stent removed after three weeks. Six months down the lane he is doing well and under neurology follow up for mild cognitive impairment. This clinical case shows the atypical, delayed perplexing presentation of esophageal foreign body in the elderly and the need for individualized treatment decision making for a successful outcome.

Keywords:
esophageal perforation chicken bone cognitive impairment endoscopy

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Chirica, M., Champault, A., Dray, X., Sulpice, L., Munoz-Bongrand, N., Sarfati, E., & Cattan, P. (2010). Esophageal perforations. Journal of Visceral Surgery, 147(3), e117-e128.
 
[2]  Mizuno, K., Takahashi, K., Tominaga, K., Nishigaki, Y., Sato, H., Ikarashi, S et al (2016). Endoscopic Removal of Ingested Dentures and Dental Instruments: A Retrospective Analysis. Gastroenterology Research and Practice, 2016, 1-5.
 
[3]  Chirica, M., Kelly, M. D., S et al. (2019). Esophageal emergencies: WSES guidelines. World Journal of Emergency Surgery, 14(1).
 
[4]  Sepesi, B., Raymond, D. P., & Peters, J. H. (2010). Esophageal perforation: surgical, endoscopic, and medical management strategies. Current Opinion in Gastroenterology, 26(4), 379-383.
 
[5]  Lexomboon, D., Trulsson, M., Wårdh, I., & Parker, M. G. (2012). Chewing Ability and Tooth Loss: Association with Cognitive Impairment in an Elderly Population Study. Journal of the American Geriatrics Society, 60(10), 1951-1956.
 
[6]  Lasch H., Castell D. O., Castell J. A. Evidence for diminished visceral pain with aging: studies using graded intraesophageal balloon distension. American Journal of Physiology-Gastrointestinal and Liver Physiology. 1997; 272(1): G1-G3.
 
[7]  Firth, M., & Prather, C. M. (2002). Gastrointestinal motility problems in the elderly patient. Gastroenterology, 122(6), 1688-1700
 
[8]  B.L.A.M Weusten, H. G. Th. Lam, L. M. A. Akkermans, G. P. Van Berge-Henegouwen, A. J. P. M. Smout (1994). Influence of age on cerebral potentials evoked by oesophageal balloon distension in humans. European Journal of Clinical Investigation, 24(9), 627-631.
 
[9]  Chen, C. Y., & Peng, J. P. (2011). Esophageal fishbone migration induced thyroid abscess: case report and review of the literature. American Journal of Otolaryngology, 32(3), 253-255.
 
[10]  Gurwara, S., & Clayton, S. (2019). Esophageal Perforations: An Endoscopic Approach to Management. Current Gastroenterology Reports, 21(11).
 
[11]  Dasari BV, Neely D, Kennedy A, Spence G, Rice P, Mackle E, et al. The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations. Ann Surg. 2014; 259(5): 852-60.