Open surgery with a lateral neck approach in cases of foreign body impaction that penetrating the neck through the oesophagus: single- center experience

Abstract

Abstract Background Because the cases of foreign body impaction penetrating the neck through the oesophagus are quite scare and doctors have not enough therapeutic experience, we aimed to review cases of foreign body impaction penetrating the neck through the oesophagus to analyze the characteristics of these cases. The open surgery skills of the surgeon, the treatment procedure and the surgeons’ experience in the rare diseases were analyzed. Methods We collected and analyzed all cases from 2015–2020 in our hospital treated with open surgery through a lateral neck approach for foreign body impaction in the neck penetrating through the cervical esophagus. The surgical area included the neck, super-mediastinum, left subclavian artery. The clinical characteristic of the cases, surgical skill and procedures for fasting and anti-infection treatment after surgery was studied retrospectively. Following up was with telephone communication. Results Our series included fifteen cases of neck and mediastinum abscesses, mediastinitis and artery aneurysmal haematoma due to cervical oesophagus foreign bodies. Tenderness in the pre-cervical site was a physical sign for screening, especially the site above the upper suprasternal fossa. All patients underwent neck, superior-mediastinum, or vessel surgeries. Thirteen cases underwent a lateral neck open surgery with the incision including the left side of neck and only two cases were incised from the right side of the neck. Pus was found 3 days after the impaction in one case, the shortest time observed in our series. the oesophageal laceration was only sutured primarily in 5 cases (33.33%) in all fifteen casas. After sufficient drainage (more than 9 days), antibiotic treatment and fasting (normally 2–3 weeks), the patients gradually began changing to solid foods from fluids after complete blood count and oesophageal radiography result confirmations. Through the following up with telephone, we learned that no severe complications occurred, and all the patients have no swallowing dis-function and recovered well. Conclusion Cervical oesophagus perforation due to impaction of a foreign body might be liable to occur in the left side of the patient’s neck. Pus and abscess cavity will begin to form after the impaction history of 3 days, so the surgery should be performed as soon as possible after foreign body impaction and penetrating the neck through oesophagus. It had better in 3 days after impaction. The lateral neck approach surgery and the therapeutic procedure introduced in this article are safe and effective treatments for cases of mis-swallowed foreign bodies penetrating the neck through esophagus.