Abstract

We report a case of impacted denture in the mid esophagus for 27 years and was successfully extracted by thoracoscopic approach. Impacted foreign body in the esophagus are common and presents with a variety of vague symptoms.^1,2 However, this particular case is interesting because denture remain lodge in esophagus for a prolonged period without Complications

Introduction

Accidental foreign body ingestion is a common problem in pediatric age group because of theirhabitual insertion of objects into their mouth and lack of posterior dentition while objects commonly ingested by elderly may be accidental or deliberate. Abdullah et al. in 1998, reported that dental prosthesis accounted for 11.5% of impacted tracheal or esophageal foreign bodies.²

We report a case of impacted denture in the esophagus of a 61-year-old male, which is unique because of theduration for which foreign body was impacted in the esophagus without complications and was successfullymanaged by thoracoscopy.

Case Report

A 61-year-old man presented to gastro surgery department with a 3-month history of dysphagia tosolids, passage of clotted blood with sputum. On investigation, his past history it was revealed thatpatient had presented 27 years ago to the emergency department with a history of ingested denture while eating. He was treated symptomatically hoping that denture will pass along with feces its own. Patient remained asymptomatic for 5-6 years then experienced dysphagia for solids. His upper gastro intestinalendoscopy revealed narrowing of lumen at 28-30 cm. and multiple biopsy were negative for malignancy.

Barium swallow showed long irregular strictured segment at D4-7 with shouldering. Patient was advisedsurgery but he refused and remained asymptomatic for next 19 years.Now, he came with complaint of hemoptysis and malena for the past two years. Endoscopy showed midesophageal impacted denture with granulation tissue and scope could not be crossed. Computed tomography(CT) imaging confirmed an irregular soft tissue density just above carina on right side (Fig. 1). Patient wasposted for thoracoscopic extraction of denture with one lung ventilation strategy using endobronchial blocker.A small incision was made on the esophagus at the level of impacted denture and was extracted (Fig. 2) with forceps. The defect in the esophagus was sutured and fine bore nasogastric tube was positioned forfeeding. Postoperatively, patient was monitored closely for any signs of surgical emphysema or mediastinitis.On the 4th postoperative day patient was discharged home after undergoing a normal water soluble contrastswallow study. Subsequent follow-up was uneventful. 

Discussion

In the aged, the commonest foreign body found is dentures because of decreased sensation of the oralcavity in denture wearer, a gradual loss of sensation and poor motor control of the laryngopharynx. The present case reveals the importance of suspicion and taking detailed history with good examination to detectforeign body.⁴ Diagnosis is difficult as these patient come with vague symptom such as neck pain, droolingof saliva choking sensation, hemoptysis, fever, regurgitation of undigested food and odynophagia.⁵

X-ray of neck (lateral view) is the most useful investigation with presence of air in the esophagusbeing a significant finding.⁶ but radiolucency of denture make radiological diagnosis difficult. It isreported that only 22% of dental prosthesis impacted in esophageal mucosa were found in lateral soft tissueneck radiograph.² It is important to know that ill-fitting and damaged denture have a risk of accidental ingestion after trauma, intoxication, loss of consciousness or sleep.⁷ Reported complications are esophageal obstructionand perforation, mediastinitis, pneumopericardium, pneumothorax, fistulas and aortic erosion.⁸ Openesophagotomy is the most effective method of extracting impacted dentures.⁹ But extraction of foreign bodyin thoracic esophagus by thoracotomy is associated with high morbidity.^2,10 Thoracoscopic approach canovercome all the morbidity of open thoracotomy. 

Conclusion

We support the importance of detailed past history with examination and to educate people for paying attentionabout the stability of denture in oral cavity. Surgery is the treatment of choice for impacted dentures asendoscopic extraction can cause perforation, and thoracoscopy minimizes the trauma of thoracotomy.

References 

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