# Esophageal Perforation by Fish Bone Ingestion Causing Purulent Pericarditis

## TL;DR

A woman died after a fish bone caused a severe infection in her heart following esophageal perforation.

## Contribution

This case highlights a rare and fatal complication of fish bone ingestion leading to purulent pericarditis.

## Key findings

- Computed tomography identified a fishbone penetrating the esophagus into mediastinal structures.
- Exploratory surgery confirmed esophageal-pericardial perforation and purulent pericarditis.
- The patient died from refractory cardiac arrest despite surgical intervention.

## Abstract

A previously healthy 38-year-old woman presented with new-onset sudden chest pain radiating to the back, associated with cough, dyspnea, nausea, vomiting, and gastric fullness after eating a bony fish. A diagnosis of gastroesophageal reflux disease was made. After a week of progressive worsening of her symptoms, she was referred to the specialist hospital. There, computed tomography imaging strongly suggested that a likely fishbone had penetrated the esophagus into the mediastinal structures; it seemed to have produced a pneumopericardium. Other tests suggested diffuse changes in ventricular repolarization, pericardial thickening, and diastolic restriction. Exploratory thoracotomy confirmed esophageal-pericardial perforation by the fishbone and purulent pericarditis. Despite appropriate surgical repair, the patient died on fifth postoperative day from an asystolic cardiac arrest that was refractory to repeated attempts to resuscitate her.