Be careful when eating a fishbone stuck could be life-threatening

19/12/2019 08:19

 

A 66-year-old woman (Phu Tho Province) suffered from fishbone stuck 1 week ago before coming to the district hospital then being transferred to the provincial hospital.

 

At the provincial hospital, an esophagoscopy was performed and the stuck fishbone caused an esophageal perforation was confirmed. The fishbone then was removed through endoscopy and she was hospitalized for monitoring. Although the fishbone was removed, the patient presented fever, shortness of breath, severe cervical pain and swelling. A CT scan was conducted and the finding was a large abscess located around the esophagus, so the patient was transferred to Viet Duc University hospital with a diagnosis of mediastinal abscess.

 

Arriving at the Hospital on November 5^th 2019, the patient had an serious infection with mild shortness of breath. Her neck was swollen and painful. At emergency department, doctors examined and confirmed the diagnosis of mediastinal abscess due to esophageal perforation caused by fishbone stuck. As soon as diagnosis was confirmed, the patient was treated urgently on emergency.

 

Assoc. Prof. Dr. Nguyen Duc Chinh – Head of Septic Surgery and Wound Care Department, Viet Duc University Hospital who operated the patient said: On CT scan, it revealed a large abscess around the esophagus spreading from cervical down to thoracic, so we performed an endoscopy on emergency for the patient first. Although no esophageal lesion was found, there was a large abscess pushed from the back in combination with a history of fishbone stuck confirmed by our colleagues from hospitals at lower levels, the diagnosis of a mediastinal abscess due to esophageal perforation after fishbone stuck again confirmed. This was a very dangerous condition with high risk of complication and could be life-threatening so it required to be handled immediately.

 

The mediastinum is a cavity located in the chest, limited above in the cervical floor and below on the diaphragm. The mediastinum contains very important organs such as large blood vessels, heart, lungs… The mediastinal abscess is a dangerous disease and without proper and in-time treatment, might lead to death due to the wide spreading of pus into the thoracic cavity, vascular injuries or rupture into the pericardial cavity… There were cases of vascular injuries by a foreign body that punctured through the esophagus, leading to necrotic gangrene and thoracic aorta rupture causing serious hemorrhage and death without any possibility to manage.

 

Later complications could occur and lead to death due to multiple organ failure because of anaerobic bacteria that are usually highly toxic.

 

This is a rare disease, since author Pearse H.E. firstly described in 1938 until now, there are many advances in diagnosis and treatment. At the beginning, the mortality rate was almost 100% and it was considered incurable. Up to now, the mortality rate in many reports was approximately 20%.

 

Through years of research at Viet Duc University Hospital, there are about10 patients with mediastinal abscess caused by esophageal perforation each year. In recent reports, the mortality rate is nearly 18%. Also, due to being a rare and complicated disease, not many studies have been published on this issues in Vietnam except in some big centers in Hanoi, Ho Chi Minh City, Hue… so many doctors do not have much experience in handling.

 

Doctors on duty and consultants from Septic Surgery and Wound Care Department, Viet Duc University Hospital urgently operated to remove a lot of pus and necrotic tissues with anaerobic bacteria and placed drainages from cervical to mediastinal cavity for continuous irrigation, associated with with high-dose antibiotic therapy. The gastric tube will be placed for about 2 weeks until the condition is stable, the incision is healed then the patient can be fed orally. Please be noted that the cervical incision for drainage was also risky because the abscess located deep, just in front of the spine so we needed to pass through cervical muscles and carotid vessels that could lead to fatal condition if being injured

Assoc. Prof. Dr. Nguyen Duc Chinh recommended: “People shout be careful when eating because even small fishbone stuck could lead to death. Especially, when it happens, the patient needs a prompt and in-time treatment in a specialized medical facilities ”.