Endoscopic Vacuum Therapy for Esophageal Perforation Treatment after Foreign Body Ingestion: Resolution after a Single Session

A 70-year-old man was admitted to the Emergency Department due to chest pain after foreign body ingestion (chicken bone) 5 days before. He mentioned having fever but denied other symptoms. Chest computed tomography (CT) scan revealed in the thoracic esophagus, in the same plane as the left atrium, a linear and dense object 30 mm in size, with signs of esophageal perforation and presence of an adjacent collection (23 × 31 × 61 mm) (Fig. 1). Following multidisciplinary discussion, it was decided to remove the foreign body and close the esophageal defect endoscopically. Upper endoscopy was performed (online suppl. Video; see www. karger.com/doi/10.1159/000503011) and confirmed the presence of a bone penetrating the esophageal wall, 32 cm from the incisors (Fig. 2). The surrounding mucosa was congestive, and purulent drainage was noticed. The foreign body was removed using an alligator jaw grasping forceps, and a 5-mm esophageal wall defect was observed (Fig. 3). We decided to perform endoscopic vacuum therapy (EVT) to try to close the defect and simultaneously treat the collection. The sponge (Endo-Sponge system, B. Braun, Melsungen, Germany) was placed in the esophageal lumen after appropriate positioning of the overtube (Fig. 4). After the procedure, the patient was admitted on total parenteral nutrition, antibiotics, and an antifungal. Five days later, upper endoscopy was repeated with sponge removal. Granulation tissue was observed at the location of the wall defect, with apparent resolution of the perforation (Fig. 5). CT was repeated showing no oral contrast leakage and significant improvement of the collection dimensions (27 × 17 mm). The patient resumed oral feeding 2 days after sponge removal, completed a 10-day antibiotic course, and was discharged. He remains well 9 months after the procedure, with no esophageal symptoms.