Instrumental esophageal perforation: A case series

Abstract

Esophageal perforation is a rare but dreadful surgical emergency. The main etiology is iatrogenic trauma, mostly related to endoscopic instrumentation. The treatment is controversial; however, surgery remains the mainstay. In this article, 3 cases of instrumental perforation of esophagus are described. In all cases, diagnosis was based on clinical, radiographic, and endoscopic findings. The first case was a 4-year-old girl with a corrosive stricture of esophagus who received 8 sessions of dilatation over 1 year; the last session resulted in perforation. Unfortunately, she was not referred to thoracic surgery at once but kept in gastroenterology department for several days, and hence, empyema developed. Conservative treatment was employed first followed by elective gastric pull-up via laparotomy and left neck incision 3 months later. She regained normal swallowing of fluid and semisolid food but developed a chronic neck sinus that required few drainage operations. The second case was of a 54-year-old man with dysphagia and a normal esophagus who developed perforation during rigid esophagoscopy. The perforation was immediately detected and an urgent primary repair was performed via left thoracotomy. The third case was of a 24-year-old man with persistent achalasia cardia despite 2 trans-abdominal esophagomyotomies. Perforation occurred during second session of pneumatic balloon dilatation but was directly referred to a thoracic surgeon who performed an urgent esophagectomy. All patients survived. We conclude that a good outcome of this potentially fatal condition is possible with early diagnosis and intervention provided by an expert surgical team.