A Case of Perforated Esophageal Ulcer Caused by an Iron Tablet

Shinya Nakashima, Tada-Aki Eto, Masayuki Hotokezaka, Masa-Hiro Kai, Yutaka Akiyama* and Kazuo Chijiiwa

Department of Surgery 1 and Department of Pathology 2*, Faculty of Medicine, University of Miyazaki

We report a rare case of perforated cervical esophageal ulcer caused by an iron tablet. A 21-year-old woman took a ferrogradumet tablet prescribed for iron deficiency anemia, thereafter suffering neck pain necessitating a visit to the hospital emergency department. Esophagoscopy showed a red tablet adhering to the cervical esophagus too tightly to be removed. Since hypaque swallowing at another hospital showed contrast medium leakage and cervical emphysema, she was transferred to our hospital. Computed tomography showed emphysema in the neck, posterior mediastinum, and retroperitoneum. Under general anesthesia, she underwent upper mediastinal drainage and endoscopic removal of the tablet buried in the esophageal wall. She had suffered from dysphagia and iron deficiency anemia for over 12 years. Histopathological examination showed epithelial injury with collagenous fiber resembling an esophageal web, indicating that an esophageal stricture from Plummer-Vinson syndrome may have caused the perforated esophageal ulcer. Careful attention should therefore be paid to a history of dysphagia, when iron tablets are prescribed for iron deficiency anemia.

Key words
esophageal ulcer, perforation, iron tablet

Reprint requests
Kazuo Chijiiwa Department of Surgery 1, Faculty of Medicine, University of Miyazaki
5200 Kihara, Kiyotake, Miyazaki, 889-1692 JAPAN

Accepted
July 27, 2005

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