Abstract
IntroductionSuccessful nonoperative management has been reported for esophageal perforation; however, some cases require surgery. Case presentationWe presented the case of an 85-year-old woman with iatrogenic thoracic esophageal perforation in whom primary repair or resection of the perforated esophagus was difficult because she was elderly and had severe aortic valve stenosis. Therefore, we selected a two-stage surgery; laparoscopic gastrostomy, jejunostomy, posterior mediastinal drainage, and cervical esophagostomy were performed. We planned reconstruction after the perforation was closed, but endoscopic examination revealed spontaneous patency of each esophageal stump. Endoscopic balloon dilation was necessary because of esophageal stenosis; however, anastomotic surgery was unnecessary. ConclusionThis case report suggests that esophageal perforation is resolved without direct closure if appropriate drainage is performed.
Highlights
Successful nonoperative management has been reported for esophageal perforation; some cases require surgery
Two-stage surgery and indirect approach may be selected based on patients’ condition, but reconstruction will be necessary after first stabilizing patients from critical situations
We reported a rare case in which esophageal perforation was resolved without direct closure and each esophageal stump achieved spontaneous patency after cervical esophagostomy using a tube
Summary
Successful nonoperative management has been reported for esophageal perforation; some cases require surgery. CASE PRESENTATION: We presented the case of an 85-year-old woman with iatrogenic thoracic esophageal perforation in whom primary repair or resection of the perforated esophagus was difficult because she was elderly and had severe aortic valve stenosis. We selected a two-stage surgery; laparoscopic gastrostomy, jejunostomy, posterior mediastinal drainage, and cervical esophagostomy were performed. We planned reconstruction after the perforation was closed, but endoscopic examination revealed spontaneous patency of each esophageal stump. Endoscopic balloon dilation was necessary because of esophageal stenosis; anastomotic surgery was unnecessary. CONCLUSION: This case report suggests that esophageal perforation is resolved without direct closure if appropriate drainage is performed
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