title: Double esophageal perforation by ingested foreign body: Endoscopic and surgical approach. A case report.
abstract: BACKGROUND
  Esophageal perforation in adults is most frequently caused by ingested foreign bodies. They can migrate through the esophageal wall, damaging the nearby organs such as the aorta or the trachea, with fatal outcome. After the diagnosis, the viable treatments for extracting the foreign body and repairing the perforation are several. The appropriate treatment, may be endoscopic, surgical or combined, depending on the level of the perforation, on the co-morbidities of the patient and on the available resources.
  
  
  METHODS
  This paper describes a case of a 68 years old patient with a double EP caused by a meat-bone that perforated the thoracic esophageal wall, approaching the aorta on the left side and the azygos vein on the right side.
  
  
  CONCLUSIONS
  Because of the double transfixion and the position near the aorta and the azygos, it was not possible to remove safely the bone during the endoscopy. The management required a combined endoscopic and surgical approach. This way it was possible to detect easily the location of the perforation, to remove safely the foreign body, to repair the perforation both from the outside and from the inside, and to place the nasogastric tube under direct vision.
  
  
  CONCLUSIONS
  Even when the type of esophageal perforation requires surgical treatment, the simultaneous use of endoscopy proved to be an advantage in order to extract the foreign body safely, to perform a double repair of the perforation and to place the nasogastric tube under direct vision.
authors.affiliation: Department of Emergency and Organ Trasplantation, University of Bari, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Ugenti
authors.affiliation: Department of Emergency and Organ Trasplantation, University of Bari, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Digennaro
authors.affiliation: Department of Emergency and Organ Trasplantation, University of Bari, Italy. Electronic address: gerrymartines@virgilio.it.
authors.forename: G
authors.initials: G
authors.lastname: Martines
authors.affiliation: Department of Emergency and Organ Trasplantation, University of Bari, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Caputi Iambrenghi
keywords: Endoscopic treatment; Esophageal perforation; Foreign body; Surgical treatment