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Acute Pericarditis Hiding an Esophageal Perforation
Catarina Osório1, Lucia Carvalho1, Ana Marta Pereira1
1General Surgery, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, PRT.
Foreign body ingestion can cause rare but fatal esophageal perforations. Prompt diagnosis and treatment are crucial, especially in elderly patients, to prevent severe complications like mediastinitis and shock.
Area of Science:
- Gastroenterology
- Thoracic Surgery
- Emergency Medicine
Background:
- Esophageal perforations from foreign bodies are infrequent but carry a high mortality risk.
- Infection of mediastinum and pericardium are the most severe complications.
- Early diagnosis and treatment are critical for patient outcomes.
Observation:
- A case of esophageal perforation presented 48 hours after symptom onset.
- The patient developed multifactorial shock, including septic and cardiogenic components.
- Pericarditis with significant pericardial and pleural effusion was noted.
Findings:
- Esophageal perforation can rapidly lead to life-threatening conditions.
- Delayed presentation increases the risk of severe systemic complications.
- Multifactorial shock and effusions indicate advanced disease progression.
Implications:
- A high index of suspicion is necessary for prompt diagnosis, particularly in older adults.
- Treatment must be individualized based on patient status and clinical factors.
- Surgical intervention, including esophageal exclusion and diversion, may be necessary in severe cases to control infection.
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