Delayed Presentation and Complex Course Secondary to Fish Bone-Induced Esophageal Perforation in an Elderly Patient:...

Esophageal perforation from foreign body ingestion is rare but potentially life-threatening, especially in elderly patients with comorbidities. Delayed presentation may lead to severe complications, including mediastinitis, sepsis, and shock. A 72-year-old female with a medical history of diabetes mellitus, hypertension, and asthma presented with progressive dysphagia and chest pain, five days after fish bone ingestion. Imaging revealed a linear hyperdense foreign body at T9-T10 and a right mediastinal collection. She underwent thoracotomy and esophageal repair over a T-tube with resection of the affected lung segment. Postoperative complications included a watershed stroke and mediastinal candida infection, requiring tracheostomy, antifungal therapy, VATS drainage, and esophageal stenting. After a prolonged hospital stay, she was discharged in stable condition. This case underscores the importance of early evaluation and multidisciplinary management in elderly patients with suspected esophageal perforation. Delays can result in complex postoperative recovery and severe systemic and infectious complications.