Zanchetta Matteo, Monti Elisa, Latham Lorenzo, Costa Jessica, Marzorati Alessandro, Odeh Murad, Colombo Elisabetta Marta, Ietto Giuseppe, Inversini Davide, Iovino Domenico, Maffioli Marco Paolo, Festi Luigi Fiorenzo, Carcano Giulio
Dipartimento di Medicina e Chirurgia, Università degli Studi dell'Insubria, 21100 Varese, Italy.
Chirurgia Generale d'Urgenza e Trapianti, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy.
Life (Basel). 2022 Jul 31;12(8):1170. doi: 10.3390/life12081170.
Foreign body ingestion in the upper digestive tract is a relatively common emergency. Less than 1% have to be treated surgically. We report the case of a 68-year-old man who ingested a dental prosthesis, probably during a seizure, and thus unknowingly, and presented two days later to the emergency department complaining of a mild dysphagia. A chest radiograph showed the presence of a removable dental prosthesis in the upper esophageal tract. The patient was brought to the operating room where a multidisciplinary equipe was assembled. Two attempts of retrieval with a flexible and a rigid endoscope failed because the removable dental prosthesis was stuck in the right pyriform sinus. Therefore, the surgeon performed an uncommon right cervicotomy and retrieved the foreign body through a right-side esophagotomy. The surgical approach depends on the nature and location of the foreign body. Urgent treatment is required whenever the patient develops dyspnea or dysphagia because of the high risk of inhalation and asphyxia. Removal of any esophageal foreign body has to be performed within 12-24 h. Repeated attempts to retrieve large dental prosthesis using an endoscope may result in esophageal perforation therefore when such risk of complication is too high, a surgical approach becomes inevitable. In our opinion, surgery remains the extrema ratio after a failed endoscopic retrieval attempt but can be lifesaving despite high risk of complications.
上消化道异物摄入是一种相对常见的急症。不到1%的患者需要接受手术治疗。我们报告一例68岁男性病例，他可能在癫痫发作期间不知不觉地吞下了一个假牙，两天后因轻度吞咽困难到急诊科就诊。胸部X线片显示上食管段有一个可取出的假牙。患者被送往手术室，多学科团队在那里集结。使用柔性和刚性内窥镜进行了两次取出尝试均失败，因为可取出的假牙卡在了右侧梨状窝。因此，外科医生进行了罕见的右侧颈部切开术，并通过右侧食管切开术取出了异物。手术方法取决于异物的性质和位置。每当患者因吸入和窒息风险高而出现呼吸困难或吞咽困难时，都需要紧急治疗。任何食管异物都必须在12 - 24小时内取出。反复尝试使用内窥镜取出大型假牙可能导致食管穿孔，因此当这种并发症风险过高时，手术方法就不可避免。我们认为，手术仍然是内窥镜取出尝试失败后的极端手段，但尽管并发症风险高，却可能挽救生命。
