Successful Endoscopic Therapy for Delayed Esophageal Perforation after Endoscopic Removal of Ingested Duck Bone

Abstract

Ingestion of a dietary foreign body is an emergency condition that requires prompt diagnosis and treatment. Delayed recognition of ingested esophageal foreign bodies can cause esophageal perforation, leading to potentially fatal complications such as mediastinitis and aortoesophageal fistula. Currently, endoscopy is the diagnostic tool of choice because it allows accurate diagnosis of the characteristics of the ingested foreign body and permits endoscopic removal. Computed tomography (CT) can help to both determine the location of the foreign body and assess any associated complications. We report the case of a 42-year-old female who presented to the hospital with chest pain and dysphagia after eating ginger duck 2 days prior. An endoscopic evaluation revealed an impacted duck bone in the mid-esophagus, which we subsequently removed. Although no immediate perforations were found during endoscopy and subsequent CT, the patient experienced worsening chest pain two days after removal of the impacted bone. Esophagography revealed an esophageal perforation and we started the patient on parenteral nutrition. Repeated endoscopy revealed esophageal perforation, and we applied two endoclips to close the wound. Repeated esophagography 14 days later revealed complete healing of the esophageal perforation and the patient was discharged on day 18 of hospitalization. This case highlights that delayed esophageal perforation may occur and clinicians should be aware of this rare complication to allow for early treatment.