Citation Information :
Bhat CK, Nachiappan M, Reddy J, Gadiyaram S. 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.
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