Abstract
BACKGROUND: Diverticula of the lower esophagus are a rare, but severe entity. 25-50 % of all patients have to be treated by surgery. Iatrogenic perforation is a major and life threatening postoperative complication. However, there is no consensus as to the best management - surgical, conservative or interventional. CASE REPORT: A 50-year-old patient underwent transabdominal diverticulotomy of an epiphrenic diverticulum. The postoperative course was complicated by an anastomotic insufficieny with mediastinitis and pleuritis. As to the critical condition surgery was no viable option. Thus, the leakage was sealed endoscopically by nine clips placed in two sessions. Afterwards the patient improved rapidly by combined external drainage, endoscopic lavage and conservative treatment. CONCLUSION: So far, reports about endoscopic treatment of iatrogenic esophageal perforations concentrated on placement of self-expandable, covered stents. This ist the first report on a positive outcome after endoscopic clipping of the leak. Endoscopic clipping, combined with conservative treatment, can be a promissing option for these critical patients.
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