Triple Thoracic Injury Caused by Foreign Body Ingestion: A New Approach for Managing an Unusual Case

Patient: Male, 31-year-old Final Diagnosis: Esophageal perforation Symptoms: Chest pain Medication: — Clinical Procedure: — Specialty: Surgery OBJECTIVE: Unusual clinical course BACKGROUND: In most cases, esophageal perforation is caused by ingested foreign bodies which can migrate through the esophageal wall, damaging nearby vital organs like the aorta or pericardium, thereby having potentially fatal outcomes. Early diagnosis and intervention are key to decreasing morbidity and mortality. Appropriate treatment involves extracting the foreign body, repairing the esophagus and other injured organs (aorta, trachea, or pericardium), and draining and cleaning the mediastinum. CASE REPORT: A 31-year-old man presented with a 2-h history of severe chest pain radiating to the back and associated with profuse sweating after eating. The patient had ingested a sharp metal object that injured the thoracic esophageal wall close to the aorta and the left atrium, causing hemopericardium. The presence of pericardial effusion on echocardiogram examination raised a high suspicion of cardiac and/or aortic injury. Left thoracotomy was done because the injury was in the distal third of the esophagus. Therefore, exploration of the pericardium and drainage of the mediastinum was essential, along with the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) to control the proximal aorta while exploring the thoracic aorta. CONCLUSIONS: In cases of esophageal injury when aortic involvement is suspected, we suggest using REBOA in selected cases, when an expert team is available, as a mean of gaining better proximal control over the aorta to safely explore and repair any possible injuries. This is an unusual case management scenario that needs further literature and clinical support.