# A Case of Esophageal Penetration of a Fish Bone into the Left Atrium Rescued by Urgent Surgery

## TL;DR

A 75-year-old woman had a fish bone accidentally ingested that pierced her esophagus into her left atrium, and was successfully treated with urgent surgery.

## Contribution

Reports a rare case of fish bone penetration into the left atrium successfully managed by urgent surgical intervention.

## Key findings

- Fish bone perforated the lower esophagus into the left atrium, diagnosed via CT.
- Surgery revealed a fistula but not the fish bone, which was later seen near the left atrium on postoperative CT.
- The patient was managed with antimicrobial therapy and no further complications occurred.

## Abstract

Esophageal penetration due to accidental foreign body ingestion is relatively rare but has a poor prognosis. Penetration into the left atrium is extremely rare, and only a few cases have been reported. A case of foreign body penetration into the left atrium is reported.

The patient was a 75-year-old woman who was transferred to our hospital for surgery due to fish bone perforation from the lower esophagus into the left atrium on CT. Urgent surgery was performed with the diagnosis of sepsis due to a mediastinal abscess and esophageal penetration into the left atrium caused by accidental fish bone ingestion. At surgery, only the fistula of the penetration wound in the esophagus and the left atrium could be detected, but not the fish bone. On CT after surgery, a folded fish bone was seen at the pericardium close to the left atrium. It was considered unlikely that the heart would again be perforated due to the fish bone’s length, and it was decided to follow up with continued antimicrobial therapy.

A rare, successfully rescued case of esophageal penetration of an accidentally ingested fish bone into the left atrium by urgent surgery, with collaboration between gastrointestinal and cardiovascular surgeons, is reported.