Etiology, diagnosis and treatment strategy of dental therapy-related subcutaneous emphysema / 中华口腔医学杂志

Subcutaneous emphysema is the local tissue swelling caused by the gas entering the subcutaneous tissue through the tissue gap. Although subcutaneous emphysema is usually a nonfatal and self-limited disease, in severe cases, the gas may spread to the neck, mediastinum and chest, resulting in mediastinal emphysema and other serious complications. This article reviews the etiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis of subcutaneous emphysema related to dental therapy,and operations that may cause subcutaneous emphysema in stomatology department,as well as the treatment and prognosis of subcutaneous emphysema, with a view to providing some references for dentists.

Terapia de presión negativa para pacientes con enfisema subcutáneo y neumomediastino masivo / Negative pressure therapy for patients with subcutaneous emphysemaand massive pneumomediastinum

Se han descrito diversas técnicas para el tratamiento del enfisema subcutáneo y del neumomediastino. Algunos pacientes con pequeñas perforaciones traqueales pueden ser manejados de forma expectante, salvo que requieran ventilación mecánica. Se presentan las imágenes de un paciente con enfisema subcutáneo y neumomediastino no candidato a cirugía y quien fue tratado exitosamente con terapia de presión negativa.

Different techniques have been described for the treatment of subcutaneous emphysema and pneumomediatinum. Some patients with small tracheal perforations can be managed expectantly, unless they require mechanical ventilation. Images of a patient with subcutaneous emphysema and pneumomediastinum not a candidate for surgery and who was successfully treated with negative pressure therapy are presented.

Enfisema subcutáneo relacionado con trauma facial en un adulto / Subcutaneous emphysema related to facial trauma in an adult

Se describe el caso clínico de un paciente de 45 años de edad, blanco, quien fue atendido en el cuerpo de guardia médica del Hospital Universitario Dr. Antonio Luaces Iraola, provincia de Ciego de Ávila, por presentar trauma facial, debido a caída por un resbalón y golpe en la cara con el borde de cemento de una piscina. Al realizar el examen físico se halló un enfisema cervicofacial. Se indicó tomografía axial computarizada, la cual mostró fractura de las paredes medial y lateral del seno maxilar izquierdo. Se decidió utilizar la técnica conservadora para extracción de aire mediante la colocación de agujas. El paciente evolucionó favorablemente y no tuvo recidivas.

The case report of a 45 years white patient is described who was assisted in the emergency department of Dr. Antonio Luaces Iraola University Hospital, Ciego de Ávila province, presenting a facial trauma, due to a fall by a slip and hit in the face with a swimming pool cement border. A cervicofacial emphysema was found when the physical exam was carried out. Computerized axial tomography was indicated, which showed fracture of the medial and lateral walls of the left maxillary sinus. It was decided to use the conservative technique for air extraction by means of the needles placement. The patient had a favorable clinical course and he didn't have relapses.

Neumomediastino espontáneo en pacientes COVID-19. Serie de casos / Spontaneous pneumomediastinum in COVID-19 patients. Case series

Resumen El neumomediastino espontáneo es la presencia de aire libre en el mediastino sin el antecedente de alguna causa como trauma de tórax. Es una condición benigna autolimitada que se trata en forma conservadora. El diagnóstico clínico se basa en dos síntomas: dolor torácico y disnea; y en un signo en particular: enfisema subcutáneo. Ha sido reportado en pacientes con influenza A (H1N1) y síndrome respiratorio agudo grave; sin embargo, ha sido raramente observado en pacientes con COVID-19. En este trabajo describimos seis pacientes del sexo masculino con COVID-19, con edades entre 27 y 82 años, que presentaron neumomediastino espontáneo y enfisema subcutáneo; ambos se reabsorbieron totalmente con manejo conservador.

Abstract Spontaneous pneumomediastinum is defined as the presence of free air within the mediastinum without an apparent cause such as chest trauma. It is a benign, self-limiting condition that is conservatively treated. Clinical diagnosis is based on two symptoms: chest pain and dyspnea; and on a particular sign: subcutaneous emphysema. It has been reported in patients with influenza A (H1N1) and severe acute respiratory syndrome; however, it has been rarely observed in COVID-19 patients. In this work, we describe six male patients with COVID-19, aged between 27 and 82 years, who presented with spontaneous pneumomediastinum and subcutaneous emphysema; both conditions were completely resorbed with conservative management.

Spontaneous pneumomediastinum incidence and clinical features in non-intubated patients with COVID-19

OBJECTIVES: To evaluate the presentation characteristics and disease course of seven patients with COVID-19 who spontaneously developed pneumomediastinum without a history of mechanical ventilation. METHODS: A total of seven non-intubated patients with COVID-19, of age ranging from 18-67 years, who developed spontaneous pneumomediastinum between 01 April and 01 October 2020 were included in the study. Patients' demographic data, clinical variables, and laboratory values were examined. Spontaneous pneumomediastinum was evaluated using posteroanterior chest radiography and thorax computed tomography. RESULTS: During the research period, 38,492 patients reported to the emergency department of our hospital with COVID-19 symptoms. Of these, spontaneous pneumomediastinum was detected in seven patients who had no previous history of intubation. Chronic obstructive pulmonary disease (2/7) and asthma bronchiale (2/7) were determined as the most common causes of comorbidity. CONCLUSIONS: In our study, the frequency of spontaneous pneumomediastinum developing without pneumothorax was found to be high in non-intubated patients. Whether this is related to the nature of the disease or it is a result of the increase in cases diagnosed incidentally owing to the increasing use of low-dose computed tomography should be explored in further studies.

Mediastinitis necrotizante descendente de origen dental: revisión de la literatura y presentación de un caso / Descending necrotizing mediastinitis of dental origin: a case study and review of the literature

La mediastinitis se define como una inflamación aguda severa de los tejidos conectivos ubicados en la cavidad torácica media, en la que 20% de los casos puede implicar una infección difusa y polimicrobiana del mediastino denominada mediastinitis necrotizante descendente (MND), secundaria a la propagación de una infección grave desde los tejidos bucofaríngeos o cervicales tales como infecciones odontogénicas (de 36 a 47%), faríngeas (de 33 a 45%), cervicales (15%) y otras infecciones de cabeza y cuello (5%). Clínicamente, los pacientes presentan aumento de volumen, temblores, trismus, odinofagia con disnea, disfagia, hipotensión, dolor de cuerpo y del ángulo de la mandíbula. Puede observarse signo de Hamman (crepitación mediastinal con el latido cardiaco) y enfisema subcutáneo. El manejo quirúrgico de las infecciones odontogénicas, sin importar su severidad, consta de dos principios: eliminar el foco etiológico y el vaciamiento quirúrgico de los espacios anatómicos comprometidos con la instalación de un drenaje adecuado. Se presenta el caso de un masculino de 60 años con diagnóstico de mediastinitis necrotizante descendente de origen dental (AU)

Mediastinitis is defined as a severe acute inflammation of the connective tissues affected in the middle thoracic cavity, in which 20% of cases may involve a diffuse and polymicrobial infection of the mediastinum, descending necrotizing mediastinitis (MND), secondary to the spread of a serious infection from the oropharyngeal or cervical tissues, stories such as odontogenic infections (36 to 47%), pharyngeal (33 to 45%), cervical (15%) and other head and neck infections (5%). Clinically, patients present with increased volume, tremors, trismus, odynophagia with dyspnea, dysphagia, hypotension, pain in the body and in the angle of the jaw. Hamman sign (mediastinal crepitus with heartbeat) and subcutaneous emphysema may be observed. The surgical management of odontogenic infections, regardless of their severity, consists of two principles: eliminate the etiological focus and the surgical emptying of the anatomical spaces compromised with the installation of adequate drainage. We present the case of a 60-year-old man diagnosed with descending necrotizing (AU)

Neumomediastino espontáneo idiopático. Primer caso pediátrico en Colombia / Idiopathic spontaneous pneumomediastinum. First colombian pediatric case

Resumen El neumomediastino espontáneo idiopático es la presencia de aire en el mediastino, sin ninguna causa aparente, siendo descrito en 1939 por el Dr. Hamman. Se atribuye a una fuga dinámica de aire desde los alvéolos a través del intersticio de personas jóvenes (efecto Macklin). La clínica no es específica, pero el dolor torácico agudo retroesternal y la tos, son los síntomas más orientativos; los signos más específicos son los crépitos precordiales (signo de Hamman) y el enfisema subcutáneo. La radiografía de tórax es suficiente para el diagnóstico, aunque otras técnicas de imagen sirven para evaluar causas secundarias. El tratamiento es reposo, analgésicos y, opcionalmente, oxígeno suplementario. Se presenta el caso de un niño en edad escolar con neumomediastino espontáneo sin ningún desencadenante identificable, siendo el primer caso pediátrico colombiano reportado de esta variante. MÉD.UIS.2019;32(2):47-52

Abstract Idiopathic spontaneous pneumomediastinum is the presence of air in the mediastinum, without any apparent cause, it was described in 1939 by Dr. Hamman. It is attributed to a dynamic escape of air from the alveoli through the pulmonary interstice of young people (Macklin effect). The clinical symptoms are not specific, but acute retrosternal chest pain and cough are the most indicative symptoms; the most specific signs are precordial crepitus (Hamman's sign) and subcutaneous emphysema. The chest X-ray is enough for the diagnosis; however, other imaging techniques are used to evaluate secondary causes. The treatment is rest, analgesics and, optionally, supplemental oxygen. There is presented the case of a school-age child with spontaneous pneumomediastinum without any identifiable trigger, being the first reported Colombian pediatric case of this variant. MÉD.UIS.2019;32(2):47-52

Anesthetic Consideration for Peroral Endoscopic Myotomy

A recent achalasia guideline suggests that peroral endoscopic myotomy (POEM) is a safe option for achalasia that is as effective as Heller myotomy. It is recommended that POEM should be performed under general anesthesia. The incidence of adverse events such as bleeding, perforation, and carbon dioxide insufflation-related complications was lower in POEM under endotracheal general anesthesia than in POEM under sedation. Subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumoperitoneum, and accompanying hemodynamic instability can be caused by carbon dioxide insufflation. Treatment of possible physiological changes and adverse events during the POEM procedure from the point of view of anesthesiologists may give endoscopists a new perspective on improving patient safety. The territory of therapeutic endoscopy can be expanded through cooperation with other departments, including anesthesia services. Efforts to understand different perspectives will certainly help not only secure patient safety but also expand the area of treatment.

Prehospital tracheotomy in a case of avulsion of the larynx with a comminuted fracture of the jawbone

Emergency physicians in the field are sometimes confronted with cases wherein patients cannot be intubated and ventilated. In some cases, cricothyrotomy, the method of choice for securing an emergency airway, may not have a successful outcome. We report a rare case of a 35-year-old male patient with avulsion of the larynx and a comminuted fracture of the jawbone, due to entrapment in a dung excavator. Prehospital tracheotomy was successfully performed. In cases with crush injuries to the larynx, anatomic structures, including the ligamentum conicum, are destroyed. In addition, massive subcutaneous emphysema blurs the anatomical key structures; hence, only a tracheotomy can prevent a lethal outcome.

Traumatic subcutaneous emphysema after liposuction

Traumatic subcutaneous emphysema, which is the infiltration of air into subcutaneous tissues due to trauma, is caused by various factors such as chest and/or abdominal trauma, facial fractures, and barotrauma caused by mechanical ventilation. In this case report, a 32-year-old woman developed traumatic subcutaneous emphysema after undergoing abdominal liposuction at a local clinic. She was subsequently admitted to Busan Paik Hospital, and with early diagnosis and conservative treatment, she was discharged on the seventh day of hospitalization with no complications. However, because traumatic subcutaneous emphysema may accompany other injuries for various reasons, radiological examination and various tests should be performed to prevent serious complications and sequelae.

A Case of Subcutaneous Emphysema and Pneumomediastinum after Palatine Tonsillectomy / 대한이비인후과학회지

Palatine tonsillectomy is a very common procedure and it is relatively safe and has few complications. However, some severe, although rare, complications that can lead a patient to life-threatening status can occur following palatine tonsillectomy. Subcutaneous or mediastinal emphysema is one of the severe complications. We report a case of subcutaneous emphysema and pneumomediastinum after palatine tonsillectomy in a healthy 18-year-old man. After conservative management, subcutaneous emphysema was subsided without other complications.

Caso Clínico: Neumomediastino Anterior, Secundario a Procedimiento Dental / Case Report: Anterior Pneumomediastinum, Secondary to Dental Procedure

INTRODUCCIÓN: El neumomediastino es la presencia de aire en el mediastino, tiene incidencia variable que oscila entre 1/80 000 y 1/42 000 a nivel mundial, genera una diversidad de características clínicas, puede ser secundario a entidades torácicas o extra torácicas; dentro de las causas extratorácicas, podemos asociarlo a procedimientos dentales siendo de vital importancia considerar la posibilidad y la asociación a dichos procedimientos para su diagnóstico y tratamiento adecuado. CASO CLÍNICO: Paciente de sexo femenino de 23 años, que 24 horas previas a su ingreso, se realizó procedimiento dental tipo exodoncia del tercer molar inferior izquierdo, en el que se usó instrumental manual y neumático, que debió ser suspendido; la paciente presentó dolor intenso más dificultad respiratoria, posterior a ello dolor torácico opresivo, mandibular y en cuello de lado izquierdo, acompañado de enfisema subcutáneo en hemicara izquierda, cuello bilateralmente y subclavicular izquierdo. EVOLUCIÓN: Paciente es ingresada con diagnóstico de neumomediastino secundario a procedimiento dental para tratamiento antibiótico de amplio espectro y vigilancia, durante su hospitalización por tres días permanece estable, afebril con mejoría clínica general. CONCLUSIÓN: El neumomediastino es una complicación poco frecuente tras intervenciones odontológicas, se debe sospechar por el uso de instrumental neumático que disecan los tejidos blandos faciales, del cuello y tórax; la paciente tuvo una evolución favorable en base al diagnóstico y tratamient

BACKGROUND: Neumomediastinum is defined as the presence of air in the mediastinum, It has variable incidence that oscillates between 1/80000 and 1/420000, generates a diversity of clinical characteristics. It can be secondary to thoracic or extra thoracic entities, within extrathoracic causes; it can be associated with dental procedures, being of vital importance consider the possibility and the association to this procedure to get to an adequate diagnosis and treatment. CASE REPORT: A 23-year-old female patient who, 24 hours prior to admission, underwent a dental procedure such as a third-molar left third molar extraction, in which manual instruments and pneumatics dental lathe were used, which had to be suspended; the patient presented severe pain plus respiratory difficulty, after that she presented oppressive chest pain, mandibular and left side neck, accompanied by subcutaneous emphysema in the left side of the face, neck bilaterally and left subclavicular EVOLUTION: The patient was hospitalize with a diagnosis of neumomediastinum secondary to dental procedure to receive treatment with broad spectrum antibiotic and surveillance, during her hospitalization for three days she remains stable, afebrile with general clinical improvement. CONCLUSIONS: The neumomediastinum is a rare complication after odontological interventions. It should be suspected when pneumatic instrument lathe are used that dissect facial, neck and thorax soft tissues; the patient had a favorable evolution based on the diagnosis and early treatment proposed by the doctors according to the patients symptoms.

Avulsión de bronquio fuente derecho debido a traumatismo torácico cerrado / Right main bronchus avulsion due to thoracic blunt trauma

La incidencia de roturas traqueobronquiales secundarias a un traumatismo torácico cerrado es baja, y la mayoría de estos pacientes no llegan con vida a los centros de atención hospitalaria. La presentación clínica es variable dependiendo de la localización de las lesiones, los daños asociados y si las estructuras peribronquiales permanecen íntegras. Para su diagnóstico temprano se debe tener un alto índice de sospecha clínica y una correcta interpretación de los hallazgos semiológicos y radiológicos, lo que permite su rápida y correcta resolución. La demora en el tratamiento aumenta tanto la mortalidad como las complicaciones tempranas y tardías.

The incidence of tracheobronchial ruptures secondary to blunt thoracic trauma is low and most affected patients do not arrive alive to hospitals. Clinical presentation varies with the location of lesions, associated injuries and whether the peribronchial structures remain intact. Early diagnosis requires a high index of clinical suspicion and a correct interpretation of semiologic and radiologic findings, which allows for a rapid and correct resolution. Delay in treatment increases the mortality as well as early and late complications.

Parálisis del XI par craneal secundaria a enfisema subcutáneo por uso de pieza de mano de alta velocidad en cirugía de terceros molares / Paralysis of the XI cranial nerve following subcutaneous emphysema by use of high speed handpiece in third molar surgery

Introducción: La cirugía de los terceros molares es el procedimiento quirúrgico más frecuentemente realizado por los cirujanos orales y maxilofaciales, que a pesar de contar con una vasta experiencia y entrenamiento en el área quirúrgica pueden presentarse complicaciones transoperatorias y postoperatorias. Cuando éste es realizado por un cirujano dentista de práctica general las complicaciones pueden aumentar. Presentación de caso clínico: Se trata de un paciente de 25 años de edad sometido a extracción quirúrgica de terceros molares por un dentista de práctica general, el cual realiza procedimiento quirúrgico con uso de pieza de mano de alta velocidad. Tres días posteriores al evento quirúrgico el paciente acude al Departamento de Cirugía Oral y Maxilofacial del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado por presentar edema, infl amación y crepitación en región bucal, maseterina y submandibular derecha, así como limitación a la apertura bucal de 25 mm. En tomografía computarizada contrastada se obs erva desviación de la vía aérea hacia el lado izquierdo. Se decide manejó del proceso infeccioso y de enfi sema subcutáneo con farmacoterapia y drenaje del mismo. Una vez remitido el enfi sema subcutáneo, en la cuarta semana de evolución el paciente refi ere limitación a la abducción del hombro derecho, observándose atrofi a del músculo trapecio y esternocleidomastoideo ipsilateral, correspondiente a lesión del XI par craneal. Discusión: La lesión del nervio accesorio (XI par craneal) ocasiona parálisis del músculo trapecio, principal estabilizador de la escápula que contribuye en los movimientos de fl exión, rotación y abducción del hombro. El trayecto del XI par craneal es superfi cial en el triángulo posterior del cuello presentando susceptibilidad a ser lesionado de manera iatrogénica, en este caso la utilización de pieza de mano de alta velocidad durante la extracción quirúrgica de los terceros molares generó enfi sema subcutáneo que condicionó la posible compresión del nervio accesorio, lesionando al mismo (AU)

Introduction: The third molar surgery is the most frequent surgical procedure performed by oral and maxillofacial surgeons, who despite their vast experience and training in the surgical area can present transoperatory and postoperative complications. When the oral surgery is done by a general practice dentist the complications can be increased. Case presentation: A 25-year-old male patient undergoing third molar surgery by a general practice dentist who performs a surgical procedure using a high-speed handpiece. Three days after the surgical procedure patient comes to the Department of Oral and Maxillofacial Surgery Institute for Social Security and Services for State Workers by present edema, swelling and crepitus in buccal space, masseteric and right submandibular region and limitation of mouth opening of 25 mm. Contrast computed tomography shows airway deviation to the left side. We decided to manage the infectious process and subcutaneous emphysema with antibiotic therapy and drainage. After subcutaneous emphysema was in remission, in the fourth week of evolution, the patient reported limitation of abduction of the right shoulder, with atrophy of the trapezius muscle and ipsilateral sternocleidomastoid, corresponding to a lesion of the XI cranial nerve. Discussion: Accessory nerve injury (XI cranial nerve) causes palsy of the trapezius muscle, the major stabilizer of the scapula that contributes to the fl exion, rotation and abduction movements of the shoulder. The trajectory of the XI cranial nerve is superfi cial in the posterior triangle of the neck presenting susceptibility to iatrogenic injury, in this case, the use of high-speed handpiece during the surgical extraction of the third molars, caused subcutaneous emphysema that conditioned the possible compression of the spinal nerve (AU)

Síndrome de Boerhaave / Boerhaave's syndrome

Mujer de 58 años, ingresa a urgencias por presentar dolor pleurítico en hemitórax izquierdo de fuerte intensidad, irradiada a dorso, asociado a tos seca y disnea progresiva. No tiene antecedentes de importancia. Al ingreso con tensión arterial: 80/46 mmHg, frecuencia cardiaca 112 por minuto, fre-cuencia respiratoria: 22 por minuto y temperatura: 39°C. Al examen físico: disminución del murmullo vesicular basal izquierdo con estertores y llenado capilar prolongado. Se toman laboratorios que muestran leucocitosis, neu-trofilia y elevación de azoados. Se solicita radiografía de tórax que muestra consolidación basal izquierda y enfisema subcutáneo en cuello.

Subcutaneous emphysema, a different way to diagnose / Enfisema subcutâneo: uma forma diferente de diagnosticar

Summary Introduction: Subcutaneous emphysema (SE) is a clinical condition that occurs when air gets into soft tissues under the skin. This can occur in any part of the body depending on the type of pathology. The most common site is under the skin that covers the chest wall or neck. It is characterized by painless swelling of tissues. The classic clinical sign is a crackling sensation upon touch, resembling that of touching a sponge beneath your fingers. Objective: To describe a new way to diagnose subcutaneous emphysema. Method: Our finding was a matter of serendipity while inspecting a patient with subcutaneous emphysema using a stethoscope. Instead only hearing the patient's chest, the stethoscope was gently pressed against the skin with SE and so we were able to detect a different sound. Results: This new way to diagnose subcutaneous emphysema consists in pressing the diaphragm part of stethoscope against the patient's skin where SE is supposed to be. Thus, we are able to hear a sound of small bubbles bursting. Crackle noise has an acoustic emission energy that varies between 750-1,200 Hz, considered high frequency. Conclusion: Although currently the use of imaging methods is widespread worldwide, we would like to strengthen the value of clinical examination. Auscultation is an essential diagnostic method that has become underestimated with the advances of healthcare and medicine as a whole. We therefore propose a different approach to diagnose SE.

Resumo Introdução: O enfisema subcutâneo é uma condição clínica que ocorre quando o ar entra nos tecidos sob a pele. Isso pode ocorrer em qualquer parte do corpo, dependendo do tipo de patologia. O local mais comum é sob a pele que cobre a parede torácica ou o pescoço. É caracterizado por inchaço indolor de tecidos. O sinal clínico clássico é a sensação de crepitação quando se toca a região afetada, assemelhando-se à sensação de se tocar uma esponja. Objetivo: Descrever uma nova maneira de diagnosticar enfisema subcutâneo. Método: Este achado foi uma serendipidade, caracterizada por inspeção clínica de pacientes com enfisema subcutâneo com uso de estetoscópio. Além da auscultação do tórax do paciente, o estetoscópio foi suavemente pressionado contra a pele com enfisema subcutâneo, sendo possível detectar um ruído diferente. Resultados: Essa nova maneira de diagnosticar enfisema subcutâneo consiste em pressionar o diafragma do estetoscópio contra a pele do paciente supostamente afetada por enfisema subcutâneo, sendo possível ouvir o ruído de pequenas bolhas estourando. O ruído de crepitações tem uma energia de emissão acústica que varia de 750-1.200 Hz, considerada alta frequência. Conclusão: Atualmente, o uso de métodos de imagem é generalizado em todo o mundo, mas gostaríamos de fortalecer o valor do exame clínico. Embora a ausculta seja um método de diagnóstico essencial, foi subestimado à medida que os cuidados de saúde e os medicamentos avançaram. Propomos uma maneira diferente de diagnosticar enfisema subcutâneo.

Pneumoparotitis

The objective is to review a case of pneumoparotitis and to discuss how knowledge of this unique presentation is important when making differential diagnoses in emergency medicine. A patient with recurrent subcutaneous emphysema of the head and neck is reviewed. Stenson's duct demonstrated purulent discharge. Physical examination revealed palpable crepitance of the head and neck. Fiberoptic laryngoscopy and barium esophagram were normal. Computed tomography demonstrated left pneumoparotitis and subcutaneous emphysema from the scalp to the clavicles. This is an unusual presentation of pneumoparotitis and malingering. Emergency physicians should be aware of pneumoparotitis and its presentation when creating a differential diagnosis for pneumomediastinum, which includes more life-threatening diagnoses such as airway or esophageal injuries.

Esophageal Foreign Body: Treatment and Complications / 대한소화기학회지

The most common cause of esophageal foreign bodies in adults is meat in Western countries and fish bones in Asian countries, including Korea. Although most ingested foreign bodies pass spontaneously through the esophagus without any clinical sequelae, some sharp foreign bodies, such as fish bones embedded in the esophagus, require treatment. Endoscopic management is the first choice in the treatment of esophageal foreign bodies because it is quite safe and effective. Major complications occur as a result of esophageal perforation; in particular, sharp foreign bodies, such as fish bones, are more likely to cause perforation. Complications include mediastinitis, paraesophageal abscess, pneumomediastinum, subcutaneous emphysema, pneumothorax, tracheoesophagal fistula, aortoesophageal fistula, aspiration, and asphyxia. Unnecessary delays should be avoided in endoscopic intervention for esophageal foreign bodies to prevent complications.