全介助経管栄養中の高齢者の頚部食道異物(有鈎義歯)の1例

  • 森脇 義弘
    横浜市立大学市民総合医療センター救命救急センター
  • 伊達 康一郎
    横浜市立大学市民総合医療センター救命救急センター
  • 長谷川 聡
    横浜市立大学市民総合医療センター救命救急センター
  • 内田 敬二
    横浜市立大学市民総合医療センター救命救急センター
  • 山本 俊郎
    横浜市立大学市民総合医療センター救命救急センター
  • 杉山 貢
    横浜市立大学市民総合医療センター救命救急センター

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  • A case of a cervical esophageal foreign body (artificial tooth with clasp) in a bedridden senile.

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We experienced a case of cervical esophageal foreign body (an artificial tooth with sharp clasps) in a bedridden senile, whose foreign body was extracted by operation with a resultant of early recovery. The patient was an 83-year-old man with previous histories of cerebral infarction, left hemiplasia, and dimentia due to Alzheimer's disease, and lived in a care house. The patient's activity of daily life was bedridden, and he was nourished by enteral nutrition using a nasogastric tube. We could not extract the foreign body by an upper gastrointestinal endoscope because of the difficulty of keeping the field of view. Direct traction with a Magill's forceps and a Kelly's forceps was also unsuccessful. We discussed probable strategies of treatment with patient's family. We recognized that the misswallowing of the artificial tooth was “accident” needing an active treatment to turn the patient's condition to premisswallowing, rather than “natural course based on aging”, and decided to perform an emergency operation. At the operation, incisions of the lateral wall of the hypopharynx and upper cervical esophagus were made, the artificial tooth which was penetrated into the cricoid cartilage was extracted, and primary suture of the visceral wound was performed. Although trivial anastomotic leakage occurred, he was transferred to other little hospital on the 16th postoperative day.

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