International Journal of Case Reports and Images, Vol. 10, 2019. ISSN: 0976-3198

Int J Case Rep Images 2019;10:101057Z01TB2019. www.ijcasereportsandimages.com

Brito et al. 1

CLINICAL IMAGE PEER REVIEWED | OPEN ACCESS

Esophageal perforation caused by a dental prosthesis

Telma Rodrigues Brito, Diana Gomes, Sandra Ferreira, Alberto Midões

CASE REPORT

An 83-year-old patient with dementia was admitted because of complaints of cervical discomfort, without respiratory symptoms, after what she described as having swallowed her dental prosthesis. There were no pathological findings in objective examination.

The patient underwent thoracic radiography showing a radiopaque foreign body in the cervical region in a format compatible with the history provided (Figures 1 and 2).

Endoscopic evaluation revealed that the more cephalic portion of the prosthesis was at the epiglottis level, with no possibility of endoscopic removal due to apparent resistance to mobilization.

During the maneuvers to prepare intubation and protect the airway, the prosthesis was found mobile and was removed with a Magill forceps. After that procedure, on inspection with the laryngoscope, no lesions were found, and by that time we no longer had the possibility to perform an endoscopy.

The same day cervicothoracic computed tomography described cervical and mediastinal subcutaneous emphysema (Figure 3).

During surveillance, nil per os, antibiotic therapy and proton pump inhibitor were provided. Therapy with Piperacillin-Tazobactam and Vancomycin was chosen, but due to the worsening of the clinical condition, it was necessary to add antifungal therapy on the fifth postoperative day, although the revaluation computed

Telma Rodrigues Brito1, Diana Gomes1, Sandra Ferreira2, Alberto Midões3

Affiliations: 1MD, Resident of General Surgery in the Gen-eral Surgery Department of Hospital de Santa Luzia, Viana do Castelo, Portugal; 2MD, Surgeon in the General Surgery Department of Hospital de Santa Luzia, Viana do Castelo, Portugal; 3MD, Director of the General Surgery Department of Hospital de Santa Luzia, Viana do Castelo, Portugal.Corresponding Author: Telma Rodrigues Brito, Estrada de Santa Luzia, 4904-858 Viana do Castelo, Portugal; Email: rodriguesbrito.telma@gmail.com

Received: 27 August 2019Accepted: 05 September 2019Published: 07 October 2019

tomography of this date did not reveal the existence of any collection. On the tenth postoperative day, an oral contrast study with gastrografin revealed no leakage and oral diet was resumed uneventfully.

DISCUSSION

Despite being more often in children, foreign body ingestion also occurs in adults, especially those with cognitive impairment, like the patient of this case report.

The usual location of the impaction is the cervical esophagus, for anatomic reasons, but that also depends

Figure 1: Cervical radiography, coronal view, showing a radiopaque foreign body compatible with a dental prosthesis.

International Journal of Case Reports and Images, Vol. 10, 2019. ISSN: 0976-3198

Int J Case Rep Images 2019;10:101057Z01TB2019. www.ijcasereportsandimages.com

Brito et al. 2

on the size and shape of the object. The object described in this case is a major challenge because of its size and the presence of several sharp hooks and therefore its removal

by endoluminal route without any, at least, mucosal esophageal injury would be unlikely. The prosthesis was removed because it looked mobile and we cannot know if the full-thickness perforation confirmed by the emphysema occurred previously or at that maneuver. Since the timetable of access to urgent endoscopy is limited in our hospital, and the patient showed no signs of bleeding, the patient was admitted for surveillance. Broad spectrum antibiotics were started as recommended.

Given the patient’s good clinical course after antifungal therapy was introduced, no further measures were taken. If we had endoscopy available, we could have tried to seal the leak with clips, but this strategy is not recommended when it has been several hours since the perforation. The use of endoluminal covered stent to seal the perforation was not an option because of the presumed location of the lesion in the cervical esophagus [1, 2].

CONCLUSION

Most small cervical perforations in healthy tissue without distal obstruction have a good prognosis with conservative treatment when the broad spectrum antibiotics are started within the first hours.

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Keywords: Cervical trauma, Dental prothesis, Esopha-geal perforation

How to cite this article

Brito TR, Gomes D, Ferreira S, Midões A. Esophageal perforation caused by a dental prosthesis. Int J Case Rep Images 2019;10:101057Z01TB2019.

Article ID: 101057Z01TB2019

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doi: 10.5348/101057Z01TB2019CR

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REFERENCES

1. Chirica M, Kelly MD, Siboni S, et al. Esophageal emergencies: WSES guidelines. World J Emerg Surg 2019;14:26.

2. Romero RV, Goh KL. Esophageal perforation: Continuing challenge to treatment. Gastrointestinal Intervention 2013;2(1):1–6.

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Figure 2: Cervical radiography, sagittal view, showing that the more cephalic portion of the prosthesis was at the epiglottis level.

Figure 3: Cervicothoracic computed tomography with cervical subcutaneous emphysema.

International Journal of Case Reports and Images, Vol. 10, 2019. ISSN: 0976-3198

Int J Case Rep Images 2019;10:101057Z01TB2019. www.ijcasereportsandimages.com

Brito et al. 3

Author ContributionsTelma Rodrigues Brito – Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

Diana Gomes – Acquisition of data, Interpretation of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

Sandra Ferreira – Interpretation of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

Alberto Midões – Interpretation of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any

part of the work are appropriately investigated and resolved

Guarantor of SubmissionThe corresponding author is the guarantor of submission.

Source of SupportNone.

Consent StatementWritten informed consent was obtained from the patient for publication of this article.

Conflict of InterestAuthors declare no conflict of interest.

Data AvailabilityAll relevant data are within the paper and its Supporting Information files.

Copyright© 2019 Telma Rodrigues Brito et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.

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