Spontaneous Internal Drainage of Iatrogenic Oesophageal Perforation
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 5
Abstract
Oesophageal perforation is a potentially fatal disease; however, with newer technologies many strategies are available to manage this. We present a case of a 60 year old woman with iatrogenic perforation of Zenker’s diverticulum and how she was managed. Oesophageal perforation remains a potentially fatal disease with mortality rates of 10% to 40% reported [1]. Iatrogenic injury is the most frequent cause of oesophageal perforation, with studies reporting incidence rates of 14% - 100% [2], followed by spontaneous rupture (Boerhaave syndrome) [3]. A variety of treatment options are available ranging from conservative medical therapy to radical oesophagectomy. Newer modalities with interventional endoscopy with or without placement of stents are more frequently being described [4]. 60-year old female with symptoms of dysphagia and reflux underwent diagnostic oesophago-gastroduodenoscopy (OGD). Immediately post-procedure, patient complained of chest pain and shortness of breath. Surgical emphysema was present in the neck and Computed Tomography (CT) confirmed oesophageal perforation in an upper oesophageal diverticulum (Figure 1). She remained well whilst managemened conservatively for 10 days with nasogastric tube, intravenous antibiotics and omeprazole. Subsequently the patient became septic, developing signs of mediastinitis and lung consolidation. She was transferred to Intensive care unit (ICU) where parenteral nutrition was commenced and antibiotics were changed appropriately. A repeat CT did not demonstrate any collections which required drainage, however there was a large iatrogenic oesophageal diverticulum extending from the retropharyngeal space down to the posterior mediastinum, just beyond the carina, compressing on the oesophagus. The patient also developed a neck swelling and air leak from a suspected perforated pharyngeal pouch for which ENT opinion was sought.
Authors and Affiliations
Ramya Kalaiselvan, Michael Pallot, Vinutha Shetty, Neal Townsend, Siba Senapati
Keywords
Related Articles
- EP ID EP572893
- DOI 10.26717/BJSTR.2017.01.000426
- Views 202
- Downloads 0
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