A Case of Esophageal Foreign Body (Dental Prosthesis with Sharp Clasp) saved by Emergency Thoracic Esohagectomy with Simultaneous Reconstruction

Yoshihiro Moriwaki, Hiroshi Toyoda, Takayuki Kosuge and Mitsugi Sugiyama

Critical Care and Emergency Center, Yokohama City University Medical Center

Most misingested dental prostheses are easily removed by endoscope or fall naturally into the stomach. Large dental prostheses with sharp metallic clasps, however, may easily injure the pharyngoesophageal mucosa. A 64-year-old man diagnosed with a thoracic esophageal foreign body, esophageal perforation, mediastinitis, pleural perforation, and pneumonia required emergency esophagectomy and preoperative endoscopic examination to evaluate the cervical esophagus for anastomosis and the stomach for reconstruction. No deep ulcer or perforation was seen in the cervical esophagus and no lesion in the stomach. We found purulent pleural effusion, mediastinal abscess, and pleulitis during right thoracotomy and conducted thoracic esophagectomy, drainage, and simultaneous reconstruction by gastric roll with a retrosternal route. We found that the clasp of the misingested dental prosthesis had moved vertically, scratching the esophageal mucosa then had rotated horizontally and had pricked the esophageal wall, which indicated that we should attempt to horizontal rotation on endoscopical removal. After the operation, he was treated with mechanical ventilation for 8 days and transferred to the previous hospital on the 20th postoperative day.

Key words
dental prosthesis with clasp, thoracic esophageal foreign body, emergency thoracic esophagectomy

Reprint requests
Yoshihiro Moriwaki Critical Care and Emergency Center, Yokohama City University Medical Center
4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024 JAPAN

Accepted
September 28, 2005

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