[Perforating injury of the thoracic esophagus caused by a dental prosthesis]

The perforation of the thoracic oesophagus by a swallowed foreign body is associated with a mortality rate as high as 30%. Three cases of mediastinitis due to unsuccessful endoscopic extraction of a swallowed denture are reported. The clinical signs of thoracic oesophagus perforation are recalled. In one patient, an uneventful recovery is obtained by an early thoracotomy allowing the removal of the foreign body and the repair of the perforation, associated to a feeding jejunostomy and a gastrostomy (to control gastric secretion and reflux). In the other two cases, where the delay between endoscopy and surgery was more than 12 hours, the perforated oesophagus was edematous and friable and difficulty repaired. In these two cases, an oesopleural fistula developed and oral feeding was only possible on 32th and 50th post-operative day. Oesophagogram reveals the foreign body which can nearly always be removed by endoscopy. After the oesophagoscopy, the integrity of the oesophagus must be controlled by a new X-ray transit. By this means, the eventual perforation is quickly diagnosed. This lesion and/or the unsuccessful endoscopic removal, frequent when the foreign body is a dental prosthesis, necessitate emergency surgery. Medical management and surgical treatments, such as exclusion or resection of the perforated oesophagus, are discussed.