Multidisciplinary management of a thoracic aortic-penetrating esophageal foreign body: a case report

BACKGROUND: Thoracic aortic penetration by an esophageal foreign body (EFB) is a rare, fatal emergency (> 80% mortality). Rapid multidisciplinary coordination with endovascular hemorrhage control may be lifesaving. CASE PRESENTATION: A 57-year-old woman developed retrosternal pain after eating a recently cooked fish meal. Computed tomography confirmed a fish bone penetrating the esophagus into the left subclavian artery and on the medial wall of the initial segment of the descending aorta. Preoperatively, the patient reported no tobacco or alcohol use and no long-term oral medications. Under multidisciplinary coordination: a covered endoprosthesis was pre-positioned endovascularly; rigid esophagoscopy extracted the barbed bone; immediate thoracic endovascular aortic repair (TEVAR) sealed aortic leakage post-removal. Postoperative management included dual antibiotics and antiplatelet therapy. Three-month follow-up showed intact endoprosthesis without complications. CONCLUSIONS: Prophylactic TEVAR prior to EFB removal in stable patients prevents catastrophic hemorrhage and provides a replicable multidisciplinary team (MDT) based management model. This integrated cardiothoracic-otolaryngology protocol offers a replicable model for managing this lethal condition.