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Clinical Images  |   January 2017
Esophageal Perforation Caused by Chicken Bone Ingestion
Author Notes
  • From the Departments of Internal Medicine (Dr Marple) and Gastroenterology (Dr Carter) at the William Beaumont Army Medical Center in El Paso, Texas. 
  • Disclaimer: The views expressed in this article are those of the authors and do not reflect the official policy of the Department of the Army, Department of Defense, or US Government. 
  •  *Address correspondence to Eric J. Marple, DO, 5005 N Piedras St, El Paso, TX 79920-5002. E-mail: eric.j.marple.mil@mail.mil
     
Article Information
Emergency Medicine / Gastroenterology / Imaging / Clinical Images
Clinical Images   |   January 2017
Esophageal Perforation Caused by Chicken Bone Ingestion
The Journal of the American Osteopathic Association, January 2017, Vol. 117, 63. doi:10.7556/jaoa.2017.014
The Journal of the American Osteopathic Association, January 2017, Vol. 117, 63. doi:10.7556/jaoa.2017.014

Keywords: esophagus, esophageal perforation, subcutaneous emphysema

A 33-year-old man presented to the emergency department with odynophagia 2 days after eating chicken wings. A radiographic image of the cervical spine from a lateral view revealed a 1.4-cm linear radiopaque foreign body overlying the esophagus at T1 (image A, arrow). An esophagogastroduodenoscopy showed a 3-cm chicken bone lodged horizontally at the upper esophageal sphincter. After multiple unsuccessful attempts to remove the foreign body with forceps, a ridged esophagoscopy with endoscopic scissors was used to transect and remove the bone. Physical examination of the patient’s neck the day after the removal revealed soft tissue crepitus. A computed tomographic scan showed subcutaneous emphysema in the anterior neck and mediastinum (image B, arrows), indicating esophageal perforation. Because he lacked systemic symptoms, the patient was treated conservatively with antibiotics and intravenous fluids. He showed no signs of sepsis 72 hours after treatment and required no surgical intervention. 
Foreign body impaction in the esophagus carries risk of perforation.1 Translocation of gastrointestinal content into the mediastinum caused by perforation can lead to necrotic inflammation, which can result in death.2 Age, coronary artery disease, and esophageal malignancy have been shown to be independent predictors for increased risk of mortality in patients with esophageal perforation.3 
References
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Vallböhmer D, Hölscher AH, Hölscher M, et al. Options in the management of esophageal perforation: analysis over a 12-year period. Dis Esophagus. 2010;23(3):185-190. doi:10.1111/j.1442-2050.2009.01017.x [CrossRef] [PubMed]
Biancari F, Saarnio J, Hypén L, et al. Outcome of patients with esophageal perforations: a multicenter study. World J Surg. 2014;38(4):902-909. doi:10.1007/s00268-013-2312-2 [CrossRef] [PubMed]