Ann Thorac Surg 2007;83:2239-2240
© 2007 The Society of Thoracic Surgeons
How To Do It
Video-Mediastinoscope: For Extracting Upper Esophageal Foreign Bodies
Celal Tekinbas, MD,
Muharrem Erol, MD*
Department of Thoracic Surgery, Hospital of Karadeniz Technical University, Trabzon, Turkey
Accepted for publication September 6, 2006.
* Address correspondence to Dr Erol, Esentepe Mah Taksim Harki Sok No: 8–4, Trabzon, 61100, Turkey. (Email: muharremerol{at}hotmail.com).
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Abstract
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Patients with esophageal foreign bodies require prompt diagnosis and therapy. The proximal dilatation method using a video-mediastinoscope is safe and effective in removing sharp foreign bodies from the upper esophagus, avoiding surgery and possible perforation. The technique using a video-mediastinoscope proved to be effective and safe; this may be the first use of this procedure in the literature. We recommend using video-mediastinoscope for extracting foreign bodies involving the upper esophagus narrowing.
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Introduction
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Patients with esophageal foreign bodies require prompt diagnosis and therapy. The first tasks are to determine the type of object, the time since ingestion, the location of the object, and the likelihood of associated complications. Embedded sharp or pointed foreign bodies in the esophagus can be very difficult to manage. We present a new endoscopic technique that we applied in this case.
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Technique
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A 73-year-old woman with a swallowed, impacted foreign body is presented (teeth prosthesis) in whom an urgent endoscopic removal was required (Fig 1). In her history she had a cerebrovascular accident 10 years prior. The foreign body was located in the upper esophagus narrowing. Her teeth prosthesis impacted the left upper esophageal wall. She was taken to operating room. After general anesthesia, a rigid esophagoscopy was performed. The teeth prosthesis was located with metallic hooks embedded into the cervical esophageal mucosa. The thoracic surgeon tried to extract the teeth prosthesis. Unfortunately, due to the embedded nature of the teeth prosthesis it was impossible to unhook the mucosa. Moreover, due to the size of the prosthesis, removing it through the rigid esophagoscope was impossible. Extracting the teeth prosthesis outside of the scope would increase the risk of a possible perforation. In this case, video-mediastinoscope was introduced into the cervical esophagus. We opened the blades of the video-mediastinoscope horizontally in the upper esophagus. Dilation of the proximal part of the esophagus made it possible to release the impacted, sharp foreign body from the esophageal wall. Hooks were then easily retrieved by rotating the foreign body forceps in a direction opposite the hook curve into the video-mediastinoscope; the teeth prosthesis was extracted into the video-mediastinoscope. Rigid esophagoscopy showed mucosal injury, but no evidence of perforation. The chest roentgenogram and all routine examinations revealed normal findings after the operation. Enteral feeding was initiated on postoperative day 5, and the patient was discharged without any problems on postoperative day 7. At follow-up on postoperative day 30, the patient has no problem.
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Fig 1. Antero-posterior (left) and lateral (right) roentgenogram of a 73-year-old woman with a swallowed, impacted foreign body. White arrow indicates the foreign body.
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Comment
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Foreign body ingestion remains a common problem, with an annual incidence of 13 episodes per 100,000 making it the third most common nonbiliary endoscopic emergency, resulting in approximately 1,500 deaths each year in the United States [1]. Patients who have evidence of complete esophageal occlusion or who have ingested a sharp or pointed object require urgent treatment due to the increased risk of complications. Impacted, sharp foreign bodies in the esophagus can be very difficult to manage.
Foreign body impaction in the esophagus most frequently occurs in the cervical esophagus at the cricopharyngeal level [2]. Here the use of video-mediastinoscope is recommended for extracting foreign bodies involving the upper esophagus narrowing. This is the first use of this procedure.
In summary, the proximal dilation method using a video-mediastinoscope is safe and effective in removing sharp foreign bodies from the upper esophagus, avoiding surgery and possible perforation.
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References
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- Longstreth GF, Longstreth KJ, Yao JF. Esophageal food impaction: epidemiology and therapy: a retrospective, observation study Gastrointest Endosc 2001;53:193-198.[Medline]
- Chaikhouni A, Kratz JM, Crawford FA. Foreign bodies of the esophagus Am Surg 1978;51173–9.
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Abstract
Introduction
