title: False esophageal hiatus hernia caused by a foreign body: a fatal event.
abstract: Foreign body ingestion is a common complaint in gastrointestinal clinics. It is usually not difficult to diagnose because most of the patients report a definitive history of accidental foreign body ingestion. However, in rare cases, patients do not have a clear history. Thus, the actual condition of the patient is difficult to diagnosis or is misdiagnosed; consequently, treatment is delayed or the wrong treatment is administered, respectively. This report describes a fatal case of esophageal perforation caused by an unknowingly ingested fishbone, which resulted in lower esophageal necrosis, chest cavity infection, posterior mediastinum fester, and significant upper gastrointestinal accumulation of blood. However, his clinical symptoms and imaging data are very similar with esophageal hiatal hernia. Unfortunately, because the patient was too late in consulting a physician, he finally died of chest infection and hemorrhage caused by thoracic aortic rupture. First, this case report underlines the importance of immediate consultation with a physician as soon as symptoms are experienced so as not to delay diagnosis and treatment, and thus avoid a fatal outcome. Second, diagnostic imaging should be performed in the early stage, without interference by clinical judgment. Third, when computed tomography reveals esophageal hiatus hernia with stomach incarceration, posterior mediastinal hematoma, and pneumatosis caused by esophageal, a foreign body should be suspected. Finally, medical professionals are responsible for making people aware of the danger of foreign body ingestion, especially among children, those who abuse alcohol, and those who wear dentures, particularly among the elderly, whose discriminability of foreign bodies is decreased, to avoid dire consequences.
authors.affiliation: Ya-Ping Lu, Ming Yao, Xu-Yan Zhou, Bing Huang, Department of Anesthesiology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China.
authors.forename: Ya-Ping
authors.initials: YP
authors.lastname: Lu
authors.affiliation: Ya-Ping Lu, Ming Yao, Xu-Yan Zhou, Bing Huang, Department of Anesthesiology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Yao
authors.affiliation: Ya-Ping Lu, Ming Yao, Xu-Yan Zhou, Bing Huang, Department of Anesthesiology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China.
authors.forename: Xu-Yan
authors.initials: XY
authors.lastname: Zhou
authors.affiliation: Ya-Ping Lu, Ming Yao, Xu-Yan Zhou, Bing Huang, Department of Anesthesiology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Huang
authors.affiliation: Ya-Ping Lu, Ming Yao, Xu-Yan Zhou, Bing Huang, Department of Anesthesiology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China.
authors.forename: Wei-Bo
authors.initials: WB
authors.lastname: Qi
authors.affiliation: Ya-Ping Lu, Ming Yao, Xu-Yan Zhou, Bing Huang, Department of Anesthesiology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China.
authors.forename: Zhi-Heng
authors.initials: ZH
authors.lastname: Chen
authors.affiliation: Ya-Ping Lu, Ming Yao, Xu-Yan Zhou, Bing Huang, Department of Anesthesiology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China.
authors.forename: Long-Sheng
authors.initials: LS
authors.lastname: Xu
mesh_terms: D000818:Animals; D001019:Aortic Rupture / Q000209:etiology; D001424:Bacterial Infections / Q000175:diagnosis / Q000209:etiology; D001842:Bone and Bones; D003951:Diagnostic Errors; D004939:Esophageal Perforation / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D017809:Fatal Outcome; D005399:Fishes; D005548:Foreign-Body Migration / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006470:Hemorrhage / Q000209:etiology; D006551:Hernia, Hiatal / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D017747:Seafood / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
keywords: Esophageal hiatus hernia; Esophageal perforation; Foreign body; Gastrointestinal accumulation