Ingestion of sharp esophageal foreign bodies (EFBs) such as fish bones is common and usually benign, but transmural perforation can lead to rare, life-threatening vascular complications. A 54-year-old woman presented with acute chest pain after fish bone ingestion. Computed tomography angiography (CTA) demonstrated a linear radiopaque FB penetrating the esophageal wall at the T3 level and located near the proximal descending thoracic aorta. Endoscopic removal confirmed esophageal perforation, and broad-spectrum intravenous antibiotics were initiated. Despite initial management, follow-up imaging revealed the development of a thoracic aortic pseudoaneurysm (AP) at the site of penetration, prompting urgent thoracic endovascular aortic repair (TEVAR) with adjunctive hybrid surgical measures to preserve cerebral perfusion. The postoperative course was uneventful, and subsequent imaging showed durable stent patency without evidence of infection or rupture. This case highlights the potential for delayed vascular injury following esophageal perforation, even after successful FB removal, and underscores the importance of close imaging surveillance, aggressive infection control, and coordinated multidisciplinary management to prevent progression to catastrophic aortoesophageal fistula (AEF).
Nguyen et al. (Fri,) studied this question.