Esophageal perforation from a fish bone was complicated by pericarditis and recurrent stroke in an acute stroke patient

Early diagnosis of esophageal perforation by foreign body impalement in acute stroke is difficult because of the accompanying masking neurological symptoms. Delayed detection of esophageal perforation results in devastating complications such as mediastinitis and pericarditis. Furthermore, atrial fibrillation, due to acute pericarditis, may aggravate the clinical condition as a result of increased incidence of recurrent stroke. Here we present a 59-year-old male patient who sustained an acute stroke followed by fish bone impalement in the esophagus. This was complicated by esophageal perforation with subsequent acute mediastinitis, pericarditis, and recurrent stroke with multiple cerebral infarcts. Even with thoracotomy, mediastinal drainage and broad-spectrum antibiotics, the patient passed away. This case highlights the importance of alertness and early diagnosis in the acute stroke patient with a history of fish bone impalement.