Fatal aortoesophageal fistula resulting from ingestion of chicken bone.
A 22-year-old soldier was admitted in Combined Military Hospital, Attock, with dysphagia, chest pain and haemetemesis after swallowing a chicken bone during the dinner. The symptoms relieved spontaneously next day. The chest x-ray on the day of admission raised possibility of a radiopaque foreign body in the lower oesophagus. Repeat x-ray of chest and Barium swallow on next day did not reveal any radiopaque shadow, filling defect or leakage. He was discharged after 3 days of observation, during which, he remained asymptomatic. Nine days later, he was re-admitted in Combined Military Hospital, Multan, with massive haemetemesis. The endoscopy was inconclusive as stomach was full of blood clots. Laparotomy revealed triangular piece of chicken bone in the stomach associated with bleeding gastric erosions. The bleeding sites were stitched and cauterized. Postoperatively, he complained of pain in the left side of chest associated with breathlessness. X-ray of chest and ultrasound examination showed fluid collection in the pleural cavity. On chest intubation, 500 ml of blood stained fluid was drained. There was no haemetemesis in the postoperative period and gastric aspirate remained clear. One week later, he had massive haemetemesis, went into cardiac arrest and expired. Postmortem examination showed the cause of death to be aortoesophageal fistula.
Ahmed
Maqbool
M
Department of Surgery, Combined Military Hospital, Multan.
Aslam
Mushahid
M
Atique
Muhammad
M
Nadeem
Muhammad
M
Saeed
Muhammad
M