A Case of Successful Conservative Treatment of Esophageal Perforation from Penetration of Esophageal Wall by a Fish Bone

A 71-year-old man with a history of percutaneous transluminal coronary angioplasty (PTCA) was referred to our clinic with a one-day history of a continuous substernal chest pain radiating to his left shoulder. In retrospect, he experienced chest discomfort after eating fish one day before but did not seek medical attention then. An upper gastrointestinal endoscopy was performed. The cause was not visible during the advancement of the endoscope through the esophagus, but a small segment of a fish bone protruding from an ulcerative lesion in the lower esophagus was identified while withdrawing the endoscope. The fishbone was immediately removed. A follow-up CT scan revealed pneumomediastinum. Now hem odynamically stable, the patient underwent conservative medical treatment including total parenteral nutrition (TPN) and intravenous antibiotic drugs. The patient made complete recovery. We report a case of a 71-year-old male found to have an esophageal perforation from an ingested fish bone, which was managed successfully with conservative treatment. A pertinent literature review is also included.