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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.

            © The Author(s). 2022 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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