Esophageal perforation after laparoscopic surgery: A mistake in the radiologic diagnosis

Abstract

Esophageal perforation is a life-threatening condition with significant morbidity and mortality in which early detection is crucial for the initiation of optimum treatment [Cole T, Turner M. Manifestations of gastrointestinal disease on chest radiographs. RadioGraphics 1993;13:1013–34; Gupta N, Kaman L. Personal management of 57 consecutive patients with esophageal perforation. Am J Surg 2004;187:58–63]. The most common cause of esophageal perforation is iatrogenic esophageal injury during either esophageal dilation or endoscopy [Cole T, Turner M. Manifestations of gastrointestinal disease on chest radiographs. RadioGraphics 1993;13:1013–34; Kimchi E, Staveley-O’Carroll K. Esophageal perforation. OTGS 2006;8:156–60]. The rarity of this condition and its nonspecific presentations lead to diagnostic and treatment delay in more than 50% of perforations [Gupta N, Kaman L. Personal management of 57 consecutive patients with esophageal perforation. Am J Surg 2004;187:58–63]. Diagnosis is made with a chest X-ray, CT of the thorax and abdomen, and with a swallow study with water-soluble medium contrast [Kimchi E, Staveley-O’Carroll K. Esophageal perforation. OTGS 2006;8:156–60; Gimenez A, Franquet T, Erasmus J, et al. Thoracic complications of esophageal disorders. RadioGraphics 2002;22:S247–58; Kuhlman J, Pozniak M, Collins J, et al. Radiographic and CT findings of blunt chest trauma: aortic injuries and looking beyond them. RadioGraphics 1998;18:1085–1106]. When diagnosis of esophageal perforation is delayed, morbidity and mortality increases substantially. Alternatives of treatment include nonoperative management or surgical procedures with primary repair, muscle patches, muscle flaps, esophageal diversion or esophagectomy [Kimchi E, Staveley-O’Carroll K. Esophageal perforation. OTGS 2006;8:156–60; Gimenez A, Franquet T, Erasmus J, et al. Thoracic complications of esophageal disorders. RadioGraphics 2002;22:S247–58]. We report a 63-year-old man with an esophageal perforation after laparoscopic repair of chronic gastric volvulus, the radiologic mistake in diagnosis which conditionated delay in treatment, and the surgical management.