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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
            contamination, length and location of perforation, and condition of     1.  Ambe P, Weber SA, Schauer M, et al. Swallowed foreign bodies
                                   15
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            presence of underlying esophageal pathology and in perforations   arztebl.2012.0869.
                                    15
            not amenable for primary repair.  Richardson et al. reported the     2.  Ayantunde AA, Oke T. A review of gastrointestinal foreign bodies. Int J
            successful use of aggressive surgical management with which they   Clin Pract 2006;60(6): 735–739. DOI: 10.1111/j.1368-5031.2006.00709.x.
            were able to salvage 14 of the 64 patients of esophageal perforation     3.  Ginsberg GG. Management of ingested foreign objects and food
                                                                    bolus impactions. Gastrointest Endosc 1995;41(1):33–38. DOI: 10.1016/
                                         16
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            high morbidity and delayed recovery.  The advantages of the     5.  Peng A, Li Y, Xiao Z, et al. Study of clinical treatment of esophageal
            use of minimally invasive surgery in the management esophageal   foreign  body-induced  esophageal  perforation  with  lethal
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            overall cost. 6,18                                      an impacted denture. Surg Laparosc Endosc Percutan Tech
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                                                                    with flexible endoscopy of 101 esophageal foreign bodies. Zhonghua
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            management of foreign body induced esophageal perforation     10.  Toshima T, Morita M, Sadanaga N et al. Surgical removal of a denture
            have mostly been used for extraction of the foreign body followed   with sharp clasps impacted in the cervicothoracic esophagus: report
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            transhiatal esophagectomy followed by staged minimally invasive     11.  Biancari F, D’Andrea V, Paone R, et al. Current treatment and outcome
                                                                    of esophageal perforations in adults: systematic review and meta-
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            esophageal perforation.                                 s00268-013-1951-7.
                                                                 12.  Brinster CJ, Singhal S, Lee L, et al. Evolving options in the management
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