Bilateral Empyema due to Spontaneous Esophageal Perforation

Abstract

We report the case of a 50-year-old man, with no signi“cant clinical history, who presented in an emergency department in the city of Cuzco with a 3-day history of nausea, vomiting, and progressive dyspnea. Chest X-ray revealed bilateral pleural effusion. Cytochemical analysis of the pleural ”uid was consistent with empyema. The patient developed progressive respiratory failure requiring mechanical ventilation and transfer to the intensive care unit (ICU), where he was treated with wide-spectrum antibiotics and bilateral chest drainage. He was extubated 10 days later, and transferred to our ICU in Lima. On arrival, his bilateral empyema persisted, so a computed tomography was performed with oral contrast medium, showing esophageal perforation (Fig. 1). The diagnosis of esophageal perforation was con“rmed on upper endoscopy, showing an ogivalshaped rupture in the posterior esophageal wall communicating with the mediastinum 3 cm from the gastroesophageal junction. The “stula was closed with metal clips and a nasojejunal tube was placed. The patient’s progress was favorable, enteral nutrition was well tolerated, and no signs of sepsis or respiratory failure were observed. After placement of the clips, chest drainage reduced progressively to less than 100 cc/24 h. This situation was maintained until the patient was discharged and transferred to Germany to continue his recovery, where the clips were “nally removed.