Page 81 - World Journal of Laparoscopic Surgery

Impacted Esophageal Denture with Esophageal Perforation
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problem associated with endoscopic extraction. These reports of esophageal perforation and further mediastinal contamination
together with those published earlier emphasize the fact that surgical and thereby should be avoided. Laparoscopic transhiatal eso-
removal of an impacted denture is safer as compared to endoscopic phagectomy in the emergency setting is feasible when carried out
extraction. 9,10 This is mainly due to the large size and presence of in stable patients who are not amenable for primary repair and is
metal clasps in the denture which frequently get embedded in the associated with all the advantages of minimal access surgery. This
esophageal wall making endoscopic extraction difficult. Prolonged benefit can also be extended during restoration of the alimentary
impaction of dentures leads to underlying mucosal ischemia resulting tract continuity at a later date by performing a laparoscopic retro-
in esophageal perforation. Although uncommon in comparison to sternal gastric transposition.
iatrogenic and spontaneous esophageal perforation, foreign body
induced perforation is a grave condition which if not recognized clInIcAl sIgnIfIAnce
early and treated aggressively, is associated with high morbidity
11
and mortality. Aggressive surgical intervention for esophageal This case emphasizes that multiple attempts at endoscopic retrieval
perforation was the management of choice for the predominant should be avoided in patients with an impacted foreign body as it
12
part of the twentieth century. With advances in endoscopic carries the risk of multiple perforations, precluding a primary repair
techniques over the years, endoscopic therapy is being used more at surgery, necessitating a major undertaking of an esophagectomy
13
commonly in the management of esophageal perforations. Surgical and gastric conduit reconstruction. Successful management of
intervention is still necessary in the following scenarios: Failure of an esophageal perforation in a case of attempted removal of the
endoscopic therapy, presence of underlying esophageal pathology impacted denture in the esophagus with a minimally invasive
14
or in the event of gross mediastinal contamination. Choice of approach.
surgical procedure is dictated by the time elapsed since perforation,
hemodynamic stability of the patient, degree of mediastinal references
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World Journal of Laparoscopic Surgery, Volume 15 Issue 2 (May–August 2022) 177