MANAGEMENT OF A CASE OF PNEUMOMEDIASTINUM CAUSED BY PERFORATION OF THE ESOPHAGUS THROUGH DENTURE
For the management of swallowed foreign bodies, literature does not cite a certain therapeutic behavior as a gold standard. Swallowed foreign bodies, blocked in the esophagus, represent a medical problem most commonly encountered in pediatric patients, but it is also common in adults, in the elderly and psychiatric patients. Esophageal perforation with secondary pneumomediastinum is an extremely rare complication with high mortality (50-70%). We present the case of a 65-year-old patient, known with schizophrenia, who is hospitalized for involuntary intake of a foreign body (denture). Clinically, the patient is conscious, hemodynamically stable, has a subcutaneous emphysema involving cervico-thoracic region and upper limbs. X-rays and CT’s reveal a foreign body located at the T7-T8 level with suspicion of mediastinal complication. Postero-lateral thoracotomy is performed in the sixth right intercostal space and acute mediastinal distention is observed through dental retention with esophageal microperforation under the bifurcation of the trachea. Large incision of mediastinal pleura is done, with purulent serohematic fluid discharge.
The foreign body is extracted endoscopically under the manual control of the esophagus. Gastrostomy and Beclere thoracic drainage are set. On the sixth post-op day, a reintervention is performed for persistent chylothorax, with the suture of the thoracic duct. Evolution is slowly favorable; the patient is discharged after 30 days. Sustained and aggressive therapeutic and surgical management can lead to a favorable progression even in a high mortality case such a pneumomediastinum caused by perforation of the esophagus through a foreign body.