Emergency esophagogastroscopy and surgical clip repair successfully treated acute pericarditis caused by an ingested fishbone perforating the oesophagus in a 70-year-old male.
Case Report (n=1)
No
Esophageal perforation from an ingested foreign body is a rare but important atypical cause of acute pericarditis that requires early identification with CT imaging and prompt surgical intervention.
Summary: Pericarditis is a relatively uncommon condition in emergency settings but is frequently encountered in cardiology. Viral infections are the most common cause, though it can also result from autoimmune conditions, cancer, and, in this case, trauma. A 70-year-old male patient attended the emergency department with sudden-onset, sharp, pleuritic, central chest pain. The patient reported having a fishbone stuck in his throat earlier in the day, which he had swallowed with food boluses and was pain-free after. Assessment revealed signs consistent with pericarditis, with diffuse ST segment elevation on electrocardiogram. Blood tests showed elevated inflammatory markers and negative Troponin T. A diagnosis of acute pericarditis was made, and the patient was admitted to cardiology for workup and treatment. A computed tomography (CT) scan of the thorax, abdomen, and pelvis was performed, given his persistent pain despite analgesia. It showed a foreign body at the mid-lower thoracic oesophagus, perforating through the anterior and posterior walls with surrounding inflammatory changes, with moderate low-density pericardial effusion with features of pericarditis. Emergency esophagogastroscopy was arranged, together with repair of the perforations with surgical clips by General Surgery. The patient recovered uneventfully and was discharged after one week. An interval CT Thorax was done in the outpatient setting six weeks post-discharge, showed no mediastinal collection or pneumomediastinum, and an interval decrease in size of the pericardial effusion. While viral infections remain the top cause of pericarditis, this case highlights the importance of maintaining a broad differential diagnosis of etiologies when diagnosing pericarditis. This necessitates thorough history taking and a low threshold for CT imaging, especially in older patients without preceding respiratory symptoms, immunosuppression, or known autoimmune conditions, to uncover atypical causes. Early identification and intervention are crucial to prevent complications and ensure favorable patient outcomes.
Lim et al. (Sun,) conducted a case report in Acute pericarditis secondary to oesophageal perforation (n=1). Emergency esophagogastroscopy and surgical clip repair was evaluated on Clinical recovery and resolution of pericardial effusion. Emergency esophagogastroscopy and surgical clip repair successfully treated acute pericarditis caused by an ingested fishbone perforating the oesophagus in a 70-year-old male.