162. EXPERIENCE IN PRIMARY REPAIR OVER T TUBE IN IATROGENIC OESOPHAGEAL PERFORATION

Abstract

Abstract Iatrogenic oesophageal perforation can be a devastating event following endoscopic or surgical procedures. It remains a challenge for the surgeon to intervene. The most common cause of oesophageal perforation which accounts for about 70% of the cases is iatrogenic perforation with mortality ranging from about 10 to 25%. Most of the iatrogenic perforations are from endoscopic procedures. This case report like to highlight one of the treatments for iatrogenic oesophageal perforation. A 73-year-old female presented to the ORL team with the inability to swallow and associated with choking sensation and drooling of saliva for 2 days. The patient developed intrascapular pain post-Rigid Esophagoscopy which intensified postprandially, and developed respiratory distress with excruciating pain over the centre of the chest anteriorly and intrascapular region. Examination revealed reduce air entry of the right lung with Xray revealed right pneumothorax with a collapsed lung. CT Thorax revealed mid-oesophageal injury at above the carina with extravasation of oral contrast. Oesophagogastroduodenoscopy, Right Thoracotomy, Primary Oesophageal perforation repair over T-tube, Right Thoracic Decortication, and Washout were done. Defect at mucosa anteriorly with stricture 23 cm and submucosal flap 28 cm from the incisor into the left thoracic cavity with perforation at the right lateral wall of the oesophagus 5 cm below the azygos vein crossing point. Myotomy performed and T-tube catheter inserted as control fistula. Oesophageal repair done and 2 chest tubes inserted at the site of perforation and base of thorax. Intraoperatively right lung expanded well. A contrast swallow study on day 46 shown no evidence of fistula between trachea and oesophagus or leak. The surveillance endoscope showed remarkable healing. Iatrogenic oesophageal perforation remains amongst the main causes for oesophageal emergencies which require proper planning, and prompt management. Proper selection of both non-operative and operative management are interchangeable with the time, and progression of a patient’s conditions. As these cases are rarely encountered thus such cases should be managed at a centre that is equipped with a trained, and experienced specialist unit, thus preventing misdiagnosis, undertreated treatment, and unwanted outcomes.