A case of intractable fistula after oesophageal perforation by a fish bone successfully closed by endoscopic fistula filling

Abstract

The patient was a 56-year-old man whose chief complaint was left chest pain after excessive eating and drinking (fish head soup) and who was referred to our department with suspected foreign body in his esophagus. Free air was observed around the aorta by CT. Since a fish bone was stuck in the left wall of the lower esophagus, it was removed endoscopically. Despite percutaneous thoracic cavity drainage for accumulated left pleural effusion, pleural effusion increased and aggrabvated mediastinitis was observed on day 7. Though mediastinal drainage was successfully performed thorascopically, puncture drainage under CT was necessary for MRSA pulmonary suppuration in the left lower lobe. On day 42, the remaining fistula was endoscopically filled by factor XIII with fibrinogen (Beriplast^®). The fistala closed, and the patient was discharged on day 56. We report an experience of the intractable fistula after oesophageal perforation by a fish bone successfully closed by endoscopic fistula filling.