Page 78 - World Journal of Laparoscopic Surgery

CASE REPORT
Staged Management for Impacted Denture with Esophageal

Perforation: Minimally Invasive Esophagectomy and

Retrosternal Gastric Pull-up

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Chaitra K Bhat , Murugappan Nachiappan , Jayanth Reddy , Srikanth Gadiyaram 4
AbstrAct
Aim: This case report aims to show the feasibility of minimally invasive surgery in the management of impacted denture in the esophagus
complicated with perforation and mediastinitis.
Background: Foreign body impaction in the esophagus due to accidental or intentional swallowing is a rare but serious gastrointestinal
emergency. Dentures are among the common causes of esophageal foreign body impaction in elderly, merely due to the presence of sharp
clasp at the edges and their sheer size. The surgical intervention in these situations is rare but may be required following failed endoscopic
extraction and for management of underlying esophageal perforation.
Case description: A 54-year-old lady presented to us within 24 hours following repeated attempts at endoscopic extraction of an accidentally
swallowed denture. She had developed esophageal perforation with mediastinitis. Computed tomography (CT) showed a denture impacted
4 cm above the gastroesophageal junction with esophageal perforation, minimal mediastinal contamination, and extensive subcutaneous
emphysema. After hemodynamic stabilization, the patient underwent an emergency laparoscopic transhiatal esophagectomy with end cervical
esophagostomy and feeding jejunostomy. Elective reconstruction was performed after six weeks. A laparoscopic retrosternal gastric pull-up
with cervical esophagogastric anastomosis was performed.
Conclusion: Laparoscopic transhiatal esophagectomy in the emergency setting is feasible when carried out in stable patients who are not
amenable for primary repair and is associated with all the advantages of minimal access surgery. Minimally invasive reconstruction is feasible
at a later date using a gastric conduit and the retrosternal route.
Clinical significance: This case emphasizes that multiple attempts at endoscopic retrieval should be avoided in patients with an impacted
foreign body as it carries the risk of multiple perforations, precluding a primary repair at surgery, necessitating a major undertaking of a staged
esophagectomy and gastric conduit reconstruction.
Keywords: Denture, Esophagus, Esophageal perforation, Foreign body, Minimally invasive esophagectomy.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1510

IntroductIon 1–4 Department of Surgical Gastroenterology, Sahasra Hospital,
Foreign body impaction in the esophagus due to accidental Bengaluru, Karnataka, India
or intentional swallowing is a rare but serious gastrointestinal Corresponding Author: Srikanth Gadiyaram, Department of Surgical
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emergency. In adults, this is seen in the background of pre- Gastroenterology, Sahasra Hospital, Bengaluru, Karnataka, India,
existing esophageal pathology and in those with underlying e-mail: srikanthgastro@gmail.com
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psychiatric illness or mental retardation. Dentures are among the How to cite this article: Bhat CK, Nachiappan M, Reddy J, et al. Staged
common causes of esophageal foreign body impaction in elderly, Management for Impacted Denture with Esophageal Perforation:
merely due to the presence of sharp clasp at the edges and their Minimally Invasive Esophagectomy and Retrosternal Gastric Pull-up.
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sheer size. The surgical intervention in these situations is rare but World J Lap Surg 2022;15(2):174–178.
may be required following failed endoscopic extraction and for Source of support: Nil
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management of underlying esophageal perforation. This report Conflict of interest: None
describes successful use of minimally invasive esophagectomy
followed by staged esophageal replacement in the management
of denture induced esophageal perforation. tomography (MDCT) was done after aggressive fluid resuscitation.
The report of MDCT showed a denture impacted 4 cm above
the gastroesophageal junction with esophageal perforation,
cAse descrIptIon
minimal mediastinal contamination, and extensive subcutaneous
A 54-year-old lady presented to us within 24 hours following emphysema (Fig. 1). After hemodynamic stabilization the patient
repeated attempts at endoscopic extraction of an accidentally underwent an emergency laparoscopic transhiatal esophagectomy
swallowed denture. Following the endoscopic procedure, she had with end cervical esophagostomy and feeding jejunostomy.
developed progressively worsening chest pain and dyspnea. She
was in circulatory shock (pulse rate, 110/min; blood pressure, 90/60 Surgical Procedure
mm Hg) and had extensive subcutaneous emphysema over the • Under general anesthesia, with the patient placed in supine leg
face, neck, chest, and upper abdomen. An esophageal perforation split position. Pneumperitoneum up to 14 mm Hg was created
was suspected and a multidetector contrast enhanced computed and five laparoscopic ports were inserted as shown in Figure 2.

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