Acquired Tracheo-Esophageal Fistula : A Rare Case Report of the Neglected Denture

Abstract

Introduction: Dentures are common accidental ingested foreign body (FB) especially among the elderly. It is frequent to have foreign body impacted at esophagus in adults however it is very unusual to have Tracheoesophageal fistula (TEF) caused by the denture. The diagnosis of TEF is challenging due to two reasons. Firstly, most of the dental prosthesis is radiolucent and not visible in the routine radiological investigation. Secondly, a patient with a history of swallowed dentures prosthesis may be asymptomatic initially and develops symptoms over time. On the contrary, the prolonged history of FB in the esophagus with TEF has a higher risk of developing serious complications such as pneumonia and lung abscess.Case Presentation: We report a case of a 62-year-old gentleman with a background history of hypertension and temporal lobe epilepsy presented with a history of choking on taking solid and liquid associated with significant weight loss past 2 months. He had lost his denture for almost 1 year during sleep. Endoscopic examination of the larynx showed normal anatomy but pooling of saliva. CT thorax showed a foreign body within a tracheoesophageal fistula. OGDS showed denture within a well-formed tracheoesophageal fistula. He had acquired TEF secondary to the dentures. Conclusion: Symptomatic elderly who lose their denture during sleep should not be neglected. They need immediate medical assessment thus will reduce further debilitating complications. Failing to identify and treat this condition urgently, the patient will suffer acquired trachea-oesophageal fistula on which the treatment is challenging and the morbidity and mortality are high.