527. A RIGHT CERVICOTOMIC APPROACH TO RETRIEVE A DENTAL PROSTHESIS FROM THE ESOPHAGUS

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Abstract Foreign body (FB) ingestion in the upper gastrointestinal (GI) tract is a relatively common emergency presenting numerous diagnostic and therapeutic challenges. Adults most frequently ingest FBs accidentally while eating solid food. The esophagus accounts for 57% to 75% of all FBs impactions in GI tract. More than 80% FB pass spontaneously, around 10-20% require an endoscopic removal, and less than 1% have to be treated surgically, depending on the nature and location of the FB. A 68 years old man presented to the Emergency Department complaining of a mild dysphagia since two days before. A laryngeal endoscopy showed edema of the right aryepiglottic fold; salivary stagnation hiding the pyriform sinus; edema of the right vocal cord; the airway caliber was adequate. A chest radiograph showed a dental prosthesis, probably ingested during a seizure, in the upper esophageal tract. The patient developed dyspnea and phonation difficulty due to neck swelling. An urgent CT scan showed signs of esophageal perforation and diffuse edema. A multidisciplinary equipe was assembled to properly treat the patient. In the operating room, two attempts of retrieval with a flexible and a rigid endoscope failed because the dental prosthesis was stuck in the right pyriform sinus. After a careful evaluation of the FB location, the surgeon performed a right cervicotomy, uncommon when compared with the traditional left side approach to the neck, and retrieved it through an esophagotomy. A nasogastric tube was inserted and a paraesophageal 19 Ch drain in aspiration was placed in situ. Over time, no signs of esophageal leakages were detected post-operatively and eventually the patient was able to feed with solid foods without complications. Any esophageal FB may cause potentially fatal injuries, therefore it must be retrieved within 12 to 24 hours. An endoscopic approach should be attempted first, with surgery being the extrema ratio. The surgical approach depends on the nature and location of the FB. A left cervical approach should not be regarded as dogmatic, and a right-sided approach, being equally safe and effective from a surgical point of view, could be appropriately chosen when clinically indicated.

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