Abstract

 Esophageal perforation is a very rare occurrence because accidental swallowing of foreign bodies is uncommon in adults. Thus, perforation due to swallowing of a foreign body and subsequent development of pneumomediastinum is rarely encountered by physicians. We experienced such a case and described an adult male patient who had perforated esophagus after unintentional ingestion of a salmon fish bone [1]. The patient visited our emergency department complaining of difficulty in swallowing for 4 hours. A review of history revealed that he consumed a salmon fish 4 hours ago. A plain x-ray soft tissue neck revealed suspicion of mediastinal air tracking (Figure 1) and Computed tomography (CT) of neck confirmed the hyper dense concentric wall thickening of the upper esophageal lumen at the level of thoracic inlet and pneumomediastinum seen surrounding the trachea, bilateral hilar extending superiorly in to the neck, posterior to the right common carotid artery and inferiorly up to and surrounding the distal esophagus, also pneumomediastinum more pronounced around the level of aortic arch and below the thoracic duct. Conservative medical management was done with help of thoracic surgeon and discharged after 3 days with full recovery.

Keywords: Salmon Fish; Neck; Pneumomediastinum

References

1. Ngan JH., et al. “A prospective study on fish bone ingestion. Experience of 358 patients”. Annuals of Surgery 211 (1989): 459-462.
2. Bathla G., et al. “Pictorial essay: complications of a swal-lowed fish bone”. Indian Journal ofRadiology and Imaging 21 (2011): 63-68.
3. Katsetos MC., et al. “Esophageal perforation and mediastinitis from fish bone ingestion”. South Medical Journal 96 (2003): 516-520.
4. Scher RL., et al. “Vascular injury following foreign body perforation of the esophagus. Review of the literature and report of a case”. The Annals of Otology, Rhinology, and Laryngology99 (1990): 698-702.
5. Chen AP., et al. “Aortoesophageal fistula and aortic pseudoaneurysm induced by swallowed fish bone: a report of two cases”. CardioVascular and Interventional Radiology34 (2011): S17-S19.
6. Lin ZH., et al. “Acute thyroid abscess secondary to oeso-phageal perforation”. Journal of International Medical Research 36 (2008): 860-864.
7. Tsai YS and Lui CC. “Retropharyngeal and epidural abscess from a swal-lowed fish bone”. American Journal of Emergency Medicine15 (1997): 381-382.
8. Yang CY. “The management of ingested foreign bodies in the upper digestive tract: a retrospective study of 49 cases”. Singapore Medical Journal32 (1991): 312-315.
9. Sharland MG and McCaughan BC. “Perforation of the esophagus by a fish bone leading to cardiac tamponade”. The Annals of Thoracic Surgery56 (1993): 969-971.
10. Akazawa Y., et al. “The management of possible fishbone ingestion”. Auris Nasus Larynx 31 (2004): 413-416.

Citation

Citation: Pramod Chirakkal., et al. “Silent Pneumomediastinum after Salmon Fish Ingestion - A Clinical Dilemma". Acta Scientific Otolaryngology 2.8 (2020): 17-19.

Copyright

Copyright: © 2020 Pramod Chirakkal., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.