My first rigid esophagoscopy as an otorhinolaryngology - head & neck surgery graduate
Cassey referred a 33/M epileptic patient who swallowed his dentures during a seizure the night prior. I received the patient 18 hours after his ingestion of the dentures. He also sent the photo of the patient’s soft tissue lateral neck x-ray. Seen there is thickening of the prevertebral area with some air pockets at the level of C6-C7. This would be the presumed location of the foreign body.
Drawings of the dentures showed a palatal part with two teeth in one, and a palatal part with three teeth in the other. CBC showed a WBC of 19.0. The patient underwent the procedure at 20 hours post-ingestion. When I began my rigid esophagoscopy, at 15cm from the incisors, I was able to see the palatal portion of the dentures and it took a bit of gentle tugging and rotating to be able to dislodge the foreign body until extraction. Upon re-inspection, I did not see any perforation though I saw swelling and pus. I wanted to have an nasogastric tube inserted so I asked the nurse to put it… But I did not specify that the tube should be inserted before the patient emerges from general anesthesia. We tried inserting the NGT when he woke up. But it kept coiling on our four attempts. Being cautious from actually perforating the esophagus, I decided to hold off from attempting any further. His post-operative medications were Cefuroxime IV, Dexamethasone IV.
The day after the surgery, I decided to put the patient on liquid diet. However, he began having fever along with his neck/throat pain… I was nervous for an esophageal perforation. I decided to put him back on nil per os for the time being. I switched his antibiotics to Ciprofloxacin 400mg IV and Clindamycin 300mg IV
On the his 3rd day of antibiotics I repeated CBC and his WBC went down to 12.0. Still not normal but at least it significantly improved. I still kept him on NPO. Fever was still occurring and I requested for an esophagogram with water-soluble contrast to which the mother refused because of financial constraints. I had to keep myself calm and just observe his fever pattern.
By his 5th hospital stay, he only had one episode of fever, so I allowed him to have liquids. And ordered that he may be discharged.
I still advised him and his mother though, to still watch for his ability to swallow and his neck pain. But it looks like his prognosis is good. I hope he goes home soon.
