Conservative management of esophageal perforation complicating the ingestion of a sharp foreign body: A case report

Background: Esophageal perforation is a rare but serious complication of foreign body ingestion and is associated with significant morbidity and mortality. Sharp foreign bodies are the leading cause of perforation in adults.
Case Presentation: We report the case of a 50-year-old man admitted with progressive dysphagia, hypersalivation, and cervical pain evolving for five days after ingestion of a bone fragment. Upper gastrointestinal endoscopy revealed an impacted sharp foreign body at 20 cm from the dental arches associated with an esophageal perforation. Endoscopic extraction was successfully performed. Cervicothoracic computed tomography demonstrated two esophageal wall defects communicating with peri-esophageal abscess collections, confirming complicated esophageal perforation. Despite delayed diagnosis and the presence of localized collections, the patient was managed conservatively with intravenous broad-spectrum antibiotics and proton pump inhibitors. Clinical, biological, and radiological evolution was favorable, with complete resolution of the abscesses and no evidence of contrast leakage on follow-up imaging.
Conclusion: Conservative management can be an effective therapeutic option for selected patients with esophageal perforation secondary to an impacted sharp foreign body, even in the presence of localized peri-esophageal collections, provided that close monitoring is ensured.