An Eastern perspective on oesophageal perforation: a high incidence of ingested bones.

BACKGROUND: Oesophageal perforation is uncommon, with controversy surrounding its optimal management. Our local experience shows a high incidence of oesophageal perforation secondary to ingested bones. METHODS: Fourteen patients with oesophageal perforation treated at Changi General Hospital in Singapore between January 1996 and December 2006 were retrospectively reviewed. RESULTS: The median age was 52 years (16-79 years), with eight men and six women. There were 11 thoracic perforations and 3 cervical perforations. Ten perforations were the result of foreign body ingestion, three were spontaneous and only one was iatrogenic. The offending foreign body was a fish bone in five patients, a chicken bone in four and a tooth in one. Three of our 14 patients were treated surgically. The remaining 11 patients were treated non-operatively. All nine patients with fish or chicken bone perforation were treated conservatively, except two in whom conservative therapy failed and they subsequently required surgery. The median length of hospital stay was 7 days (2-109 days). There was one death. CONCLUSION: Oesophageal perforation requires prompt diagnosis and treatment. Most of our oesophageal perforations are secondary to ingested bones. Such cases can often be treated conservatively in our experience.

Radiation ulcers of the neck should not be neglected: a case of vertebral artery blowout.

Radiotherapy for head and neck malignancies can result in late complications. Here, we report a patient with a rare vascular complication caused by radiation-induced ulcer of the head and neck region. The clinical presentation, its diagnosis, treatment and outcome are discussed.