title: Denture mis-swallowing in the sliding esophageal hiatal hernia mimics esophageal perforation.
abstract: Mis-swallowing of a foreign body in the esophagus coexisting with sliding hernia might be misdiagnosed as esophageal perforation with mediastinal abscess. We report an 89-year-old woman, bedridden for a long period in a nursing home after a previous cerebrovascular accident, who was sent to our emergency department in a state of sepsis because she had swallowed a radio-opaque partial denture. The retention of the denture as an esophageal foreign body was complicated with mediastinitis and bilateral pleural effusion. The inability of the patient to give a reliable clinical history delayed the diagnosis. This report highlights the difficulty in precisely locating a partial denture because of conflicting radiologic findings and the coexistence of esophageal sliding hernia, all of which led to a misdiagnosis of possible esophageal perforation. A right posterolateral thoracotomy with gastrostomy was performed to remove the lower esophageal foreign body after esophagoscopy failed. The surgical finding of a coincidental sliding esophageal hiatal hernia correlated well with the clinical presentation. Managing such a complicated esophageal foreign body in this elderly patient was challenging.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Chao-Yang
authors.initials: CY
authors.lastname: Chen
authors.forename: Shih-Chun
authors.initials: SC
authors.lastname: Lee
authors.forename: Chun-Wen
authors.initials: CW
authors.lastname: Chen
authors.forename: Jen-Chih
authors.initials: JC
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition; D003778:Dentures / Q000009:adverse effects*; D004939:Esophageal Perforation / Q000175:diagnosis*; D004947:Esophagus; D005260:Female; D005547:Foreign Bodies / Q000150:complications / Q000175:diagnosis*; D006551:Hernia, Hiatal / Q000150:complications*; D006801:Humans