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Canadian Journal of Gastroenterology
Volume 17, Issue 2, Pages 115-117
http://dx.doi.org/10.1155/2003/948232
Brief Communication

Esophageal Foreign Body Causing Direct Aortic Injury

ECS Lam,1 JA Brown,2 and JS Whittaker3

1Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
2Department of Radiology, St Paul’s Hospital, Vancouver, British Columbia, Canada
3Department of Medicine, St Paul’s Hospital, Vancouver, British Columbia, Canada

Received 10 June 2002; Revised 8 November 2002

Copyright © 2003 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Foreign bodies in the esophagus are uncommon causes of esophageal perforation. Many nonperforating cases are successfully managed by flexible gastroscopy. However, complicated foreign bodies such as those that result in esophageal perforation and vascular injury are best managed surgically. Gastroscopy remains the primary method of diagnosis. A case of a 59-year-old woman who developed retrosternal and intrascapular pain, odynophagia and hematemesis after eating fish is reported. Flexible gastroscopy showed arterial bleeding from the midthoracic esophagus. Computed tomography scan localized a 3 cm fish bone perforating the esophagus with surrounding hematoma. An aortogram did not reveal an actively bleeding aortoesophageal fistula. The fish bone was surgically removed and the patient recovered with no postoperative complications. This case illustrates the importance of early consideration for surgical intervention when confronted with a brisk arterial bleed from the esophagus with suggestive history of foreign body ingestion.