Citation Information :
Bhat CK, Reddy J. Staged Management for Impacted Denture with Esophageal Perforation: Minimally Invasive Esophagectomy and Retrosternal Gastric Pull-up. World J Lap Surg 2022; 15 (2):174-178.
Aim: This case report aims to show the feasibility of minimally invasive surgery in the management of impacted denture in the esophagus complicated with perforation and mediastinitis.
Background: Foreign body impaction in the esophagus due to accidental or intentional swallowing is a rare but serious gastrointestinal emergency. Dentures are among the common causes of esophageal foreign body impaction in elderly, merely due to the presence of sharp clasp at the edges and their sheer size. The surgical intervention in these situations is rare but may be required following failed endoscopic extraction and for management of underlying esophageal perforation.
Case description: A 54-year-old lady presented to us within 24 hours following repeated attempts at endoscopic extraction of an accidentally swallowed denture. She had developed esophageal perforation with mediastinitis. Computed tomography (CT) showed a denture impacted 4 cm above the gastroesophageal junction with esophageal perforation, minimal mediastinal contamination, and extensive subcutaneous emphysema. After hemodynamic stabilization, the patient underwent an emergency laparoscopic transhiatal esophagectomy with end cervical esophagostomy and feeding jejunostomy. Elective reconstruction was performed after six weeks. A laparoscopic retrosternal gastric pull-up with cervical esophagogastric anastomosis was performed.
Conclusion: Laparoscopic transhiatal esophagectomy in the emergency setting is feasible when carried out in stable patients who are not amenable for primary repair and is associated with all the advantages of minimal access surgery. Minimally invasive reconstruction is feasible at a later date using a gastric conduit and the retrosternal route.
Clinical significance: This case emphasizes that multiple attempts at endoscopic retrieval should be avoided in patients with an impacted foreign body as it carries the risk of multiple perforations, precluding a primary repair at surgery, necessitating a major undertaking of a staged esophagectomy and gastric conduit reconstruction.
Ambe P, Weber SA, Schauer M, et al. Swallowed foreign bodies in adults. Dtsch Arztebl Int 2012;109(50):869–875. DOI: 10.3238/arztebl.2012.0869.
Ayantunde AA, Oke T. A review of gastrointestinal foreign bodies. Int J Clin Pract 2006;60(6): 735–739. DOI: 10.1111/j.1368-5031.2006.00709.x.
Ginsberg GG. Management of ingested foreign objects and food bolus impactions. Gastrointest Endosc 1995;41(1):33–38. DOI: 10.1016/s0016-5107(95)70273-3.
Sung SH, Jeon SW, Son HS, et al. Factors predictive of risk for complications in patients with oesophageal foreign bodies. Dig Liver Dis 2011;43(8):632–635. DOI: 10.1016/j.dld.2011.02.018.
Peng A, Li Y, Xiao Z, et al. Study of clinical treatment of esophageal foreign body-induced esophageal perforation with lethal complications. Eur Arch Otorhinolaryngol 2012;269(9):2027–2036. DOI: 10.1007/s00405-012-1988-5.
Palanivelu C, Rangarajan M, Parthasarathi R, et al. Thoracoscopic retrieval of a “smiling” foreign body from the proximal esophagus: an impacted denture. Surg Laparosc Endosc Percutan Tech 2008;18(3):325–358. DOI: 10.1097/SLE.0b013e3181661919.
Ma J, Kang DK, Bae JI, et al. Value of MDCT in diagnosis and management of esophageal sharp or pointed foreign bodies according to level of esophagus. AJR Am J Roentgenol 2013;201(5):707–711. DOI: 10.2214/AJR.12.8517.
Yan XE, Zhou LY, Lin SR, et al. Complication related factors and efficacy with flexible endoscopy of 101 esophageal foreign bodies. Zhonghua Yi Xue Za Zhi 2013;93(32):2557–2561. (In Chinese). PMID: 24351596.
Nwaorgu OG, Onakoya PA, Sogebi OA, et al. Esophageal impacted dentures. J Natl Med Assoc 2004;96(10):1350–1353. PMID: 15540888.
Toshima T, Morita M, Sadanaga N et al. Surgical removal of a denture with sharp clasps impacted in the cervicothoracic esophagus: report of three cases. Surg Today 2011;41(9):1275–1279. DOI: 10.1007/s00595-010-4467-x.
Biancari F, D'Andrea V, Paone R, et al. Current treatment and outcome of esophageal perforations in adults: systematic review and meta-analysis of 75 studies. World J Surg 2013;37(5):1051–1059. DOI: 10.1007/s00268-013-1951-7.
Brinster CJ, Singhal S, Lee L, et al. Evolving options in the management of esophageal perforation. Ann Thorac Surg 2004;77(4):1475–1483. DOI: 10.1016/j.athoracsur.2003.08.037.
Carrott PW Jr, Low DE. Advances in the management of esophageal perforation. Thorac Surg Clin 2011;21(4):541–555. DOI: 10.1016/j.thorsurg.2011.08.002.
Athanassiadi K, Gerazounis M, Metaxas E. Management of esophageal foreign bodies: a retrospective review of 400 cases. Eur J Cardiothorac Surg 2002;21(4);653–656. DOI: 10.1016/s1010-7940(02)00032-5.
Eroglu A, Turkyilmaz A, Aydin Y, et al. Current management of esophageal perforation: 20 years experience. Dis Esophagus 2009;22(4):374–380. DOI: 10.1111/j.1442-2050.2008.00918.x.
Richardson JD. Management of esophageal perforations: the value of aggressive surgical treatment. Am J Surg 2005; 190(2):161–165. DOI: 10.1016/j.amjsurg.2005.05.004.
Lindenmann J, Matzi V, Neuboeck N, et al. Management of esophageal perforation in 120 consecutive patients: clinical impact of a structured treatment algorithm. J Gastrointest Surg 2013; 17(6):1036–1043. DOI: 10.1007/s11605-012-2070-8.
Dalvi AN, Thapar VK, Jagtap S, et al. Thoracoscopic removal of impacted denture: Report of a case with review of literature. J Minim Access Surg 2010; 6(4):119–121. DOI: 10.4103/0972-9941.72600.