Esophageal perforation caused by fish vertebra ingestion in a seven-month-old infant demanded surgical intervention: A case report

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 tomography (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.

Figure 1

A: Extensive pneumomediastinum and air collections in retropharyngeal area (arrows), B: Irregular hyperdense lesion (arrow head) around cricopharyngeal area, and intra-esophageal opacification (arrow) was noted at C3 - C4 level.

Figure 2

A: Esophageal rupture with retropharyngeal air collection (arrow), and B: Irregular foreign body impacted at upper esophagus (arrow).

Figure 3

Much air collection (arrow) was in the retropharyngeal space and mediastinum, contrast leakage (arrow head) into the retropharyngeal space with opacification of a small fistulous tract at C3-4 level (cricopharyngeal level), suggestive of esophageal perforation.

Figure 4

The fish vertebra with three sharp spines, which is about 1 cm x 1 cm in size, was removed by grasping forceps.