A new management approach for esophageal perforation

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We present the case of a 40-year-old man with spontaneous esophageal perforation following an episode of ethanol intoxication. The diagnosis of perforation was delayed due to refusal of intervention. Endoscopic examination of the upper part of the esophagus revealed the tear above the gastroesophageal junction. A Polyflex self-expanding coated stent (Willy Ruesch GMBH, Kernen, Germany) was placed, isolating and sealing the area of perforation and restoring esophageal continuity. A left thoracoscopy was performed to drain and debride the mediastinum. The patient was discharged eating a regular diet and the Polyflex stent was removed 1 month later. This case is unique because a combined minimally invasive approach was used to manage a complex potentially fatal surgical emergency, which was previously handled through open thoracotomy. Because we combined video-assisted thoracic surgery and upper esophageal endoscopy, the patient experienced minimal morbidity and a short hospital stay with rapid return to activities of daily living. We believe this is the first reported case in which these combined modalities were used in the primary management of spontaneous esophageal perforation. Clinical Summary A 40-year-old man celebrated graduate school completion with an evening of hard liquor consumption. Three hours later, he began having indigestion and epigastric discomfort, followed by intermittent vomiting and retching. The patient was taken to his local hospital because of back pain and difficulty breathing.