Digestive and Liver Disease 47 (2015) 255
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Bone as a foreign body Hong-Sheng Zhang a , Xiao-Xia Wang b,1 , Hao Qin c , Jian-Chao Sui c,∗ a
Department of Radiology, Wendeng Central Hospital of Weihai, The Affiliated Hospital of Weifang Medical College, Weihai, China Department of Clinical Oncology, Wendeng Central Hospital of Weihai, The Affiliated Hospital of Weifang Medical College, Weihai, China c Department of Gastroenterology, Wendeng Central Hospital of Weihai, The Affiliated Hospital of Weifang Medical College, Weihai, China b
A 50-year-old woman was admitted to our gastroenterology department because of mild and occasional pain in the thyroid region and in the mid-sternum that radiated to the interscapular region. Computed tomography (CT) showed a 3.0 cm fishbone that had penetrated the oesophageal wall and was embedded very close to the aorta (Fig. 1). She was prescribed medication to deal with the discomfort because she could not afford to pay for surgical treatment and endoscopy. At a follow-up visit 23 days after ingestion of the fishbone, the woman felt her upper extremity tingling. CT revealed the fishbone had entered the left brachial artery through the left subclavian artery (Fig. 2). The situation was explained to the patient and she consented to surgery. The fishbone was removed successfully, hospital stay was uncomplicated. She was doing well at 12-month follow-up and upper endoscopy was negative.
Fig. 2.
A primary fistula between the aorta and the oesophagus is rare and usually fatal. The main aetiological factors involve aneurysms (54.2%), foreign bodies (19.2%) and advanced oesophageal cancer (17.0%) [1]. The precise diagnosis can be very difficult because the foreign body may migrate and endoscopy often fails to identify it. CT scanning should be performed as soon as the diagnosis is suspected. Reference
Fig. 1.
[1] Hollander JE, Quick G. Aortoesophageal fistula: a comprehensive review of the literature. American Journal of Medicine 1991;91:279–87.
∗ Corresponding author at: Wendeng Central Hospital of Weihai, The Affiliated Hospital of Weifang Medical College, 3 East Mi-shan Road, Weihai 264400, Shandong, China. Tel.: +86 0631 8800655. E-mail address: [email protected] (J.-C. Sui). 1 This author contributed equally to this work. http://dx.doi.org/10.1016/j.dld.2014.10.003 1590-8658/© 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Contents lists available at ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Bone as a foreign body Hong-Sheng Zhang a , Xiao-Xia Wang b,1 , Hao Qin c , Jian-Chao Sui c,∗ a
Department of Radiology, Wendeng Central Hospital of Weihai, The Affiliated Hospital of Weifang Medical College, Weihai, China Department of Clinical Oncology, Wendeng Central Hospital of Weihai, The Affiliated Hospital of Weifang Medical College, Weihai, China c Department of Gastroenterology, Wendeng Central Hospital of Weihai, The Affiliated Hospital of Weifang Medical College, Weihai, China b
A 50-year-old woman was admitted to our gastroenterology department because of mild and occasional pain in the thyroid region and in the mid-sternum that radiated to the interscapular region. Computed tomography (CT) showed a 3.0 cm fishbone that had penetrated the oesophageal wall and was embedded very close to the aorta (Fig. 1). She was prescribed medication to deal with the discomfort because she could not afford to pay for surgical treatment and endoscopy. At a follow-up visit 23 days after ingestion of the fishbone, the woman felt her upper extremity tingling. CT revealed the fishbone had entered the left brachial artery through the left subclavian artery (Fig. 2). The situation was explained to the patient and she consented to surgery. The fishbone was removed successfully, hospital stay was uncomplicated. She was doing well at 12-month follow-up and upper endoscopy was negative.
Fig. 2.
A primary fistula between the aorta and the oesophagus is rare and usually fatal. The main aetiological factors involve aneurysms (54.2%), foreign bodies (19.2%) and advanced oesophageal cancer (17.0%) [1]. The precise diagnosis can be very difficult because the foreign body may migrate and endoscopy often fails to identify it. CT scanning should be performed as soon as the diagnosis is suspected. Reference
Fig. 1.
[1] Hollander JE, Quick G. Aortoesophageal fistula: a comprehensive review of the literature. American Journal of Medicine 1991;91:279–87.
∗ Corresponding author at: Wendeng Central Hospital of Weihai, The Affiliated Hospital of Weifang Medical College, 3 East Mi-shan Road, Weihai 264400, Shandong, China. Tel.: +86 0631 8800655. E-mail address: [email protected] (J.-C. Sui). 1 This author contributed equally to this work. http://dx.doi.org/10.1016/j.dld.2014.10.003 1590-8658/© 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
