Two-stage Surgery for Delayed Esophageal Perforation and Concomitant Chylothorax Secondary to Upper Gastrointestinal Endoscopy

Overview

Journal Ann Med Surg (Lond)

Publisher Wolters Kluwer

Specialty Medical Education

Date 2022 May 31

PMID 35637995

Authors

Ikram Ul Haq Chaudhry

Abdullah M Al Ghamdi

Othman M Al Fraih

Hisham Al Maimon

Yousif A Alqahtani

Farjad Tariq Khan

Fathi A Al Rasheed

Meenal A Al Abdulhai

Affiliations

Soon will be listed here.

Abstract

A 46 years old male smoker was admitted to our hospital with a three-month history of chest discomfort and burning sensations due to regurgitation of food. The gastroenterologist tried multiple attempts to pass the endoscope through the lower end of the esophagus but failed. Post endoscopy Chest -X-ray showed right hemithorax fluid collection. A 28Fr chest drain was inserted, and fluid analysis revealed chyle. A contrast computed tomographic scan of the chest (CT) revealed esophageal perforation. The patient was managed conservatively by the primary physician on TPN, Antibiotics, and keeping him nil by mouth. After two weeks of failed conservative management, they referred the patient to the thoracic surgeon. We planned two-stage surgery because the patient was critically sick, septic, and hemodynamically unstable on inotropic support.

References

Mongelli F, FitzGerald M, Cafarotti S, Inderbitzi R . Chylothorax after endoscopic ultrasound with fine-needle aspiration causing migrating appearance of a solitary fibrous tumor of the pleura. Ann Thorac Med. 2018; 13(2):114-116. PMC: 5892086. DOI: 10.4103/atm.ATM_340_17. View

Silvis S, Nebel O, Rogers G, Sugawa C, MANDELSTAM P . Endoscopic complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey. JAMA. 1976; 235(9):928-30. DOI: 10.1001/jama.235.9.928. View

Kotsis L, Agocs L . The effectiveness of diaphragmatic pedicled grafts in esophageal injuries and wall reconstruction. Eur J Cardiothorac Surg. 1998; 14(2):218-20. DOI: 10.1016/s1010-7940(98)00175-4. View

Kavic S, Basson M . Complications of endoscopy. Am J Surg. 2001; 181(4):319-32. DOI: 10.1016/s0002-9610(01)00589-x. View

White C, Templeton P, Attar S . Esophageal perforation: CT findings. AJR Am J Roentgenol. 1993; 160(4):767-70. DOI: 10.2214/ajr.160.4.8456662. View

Selle J, Snyder 3rd W, SCHREIBER J . Chylothorax: indications for surgery. Ann Surg. 1973; 177(2):245-9. PMC: 1355573. DOI: 10.1097/00000658-197302000-00022. View

Ohri S, Liakakos T, Pathi V, Townsend E, Fountain S . Primary repair of iatrogenic thoracic esophageal perforation and Boerhaave's syndrome. Ann Thorac Surg. 1993; 55(3):603-6. DOI: 10.1016/0003-4975(93)90261-f. View

BARRETT N . Spontaneous perforation of the oesophagus; review of the literature and report of three new cases. Thorax. 2010; 1:48-70. PMC: 1018211. DOI: 10.1136/thx.1.1.48. View

Habr-Gama A, Waye J . Complications and hazards of gastrointestinal endoscopy. World J Surg. 1989; 13(2):193-201. DOI: 10.1007/BF01658399. View

10.

Moghissi K, Pender D . Instrumental perforations of the oesophagus and their management. Thorax. 1988; 43(8):642-6. PMC: 461402. DOI: 10.1136/thx.43.8.642. View

11.

SATINSKY V, Kron S . One-stage esophagectomy in presence of mediastinitis. AMA Arch Surg. 1952; 64(1):124-7. DOI: 10.1001/archsurg.1952.01260010135017. View

12.

Daniel W, Erbel R, Kasper W, Visser C, Engberding R, Sutherland G . Safety of transesophageal echocardiography. A multicenter survey of 10,419 examinations. Circulation. 1991; 83(3):817-21. DOI: 10.1161/01.cir.83.3.817. View

13.

Bethge N, Kleist D, Vakil N . Treatment of esophageal perforation with a covered expandable metal stent. Gastrointest Endosc. 1996; 43(2 Pt 1):161-3. DOI: 10.1016/s0016-5107(06)80123-9. View

14.

Okten I, Cangir A, Ozdemir N, Kavukcu S, Akay H, Yavuzer S . Management of esophageal perforation. Surg Today. 2001; 31(1):36-9. DOI: 10.1007/s005950170217. View

15.

Jougon J, Cantini O, Delcambre F, Minniti A, Velly J . Esophageal perforation: life threatening complication of endotracheal intubation. Eur J Cardiothorac Surg. 2001; 20(1):7-10; discussion 10-1. DOI: 10.1016/s1010-7940(01)00766-7. View

16.

Bufkin B, Miller Jr J, Mansour K . Esophageal perforation: emphasis on management. Ann Thorac Surg. 1996; 61(5):1447-51; discussion 1451-2. DOI: 10.1016/0003-4975(96)00053-7. View

17.

JAMES Jr A, Montali R, Chaffee V, Strecker E, Vessal K . Barium or gastrografin: which contrast media for diagnosis of esophageal tears?. Gastroenterology. 1975; 68(5 Pt 1):1103-13. View

18.

Flynn A, Verrier E, Way L, Thomas A, Pellegrini C . Esophageal perforation. Arch Surg. 1989; 124(10):1211-4; discussion 1214-5. DOI: 10.1001/archsurg.1989.01410100117020. View

19.

Dugue L, Sauvanet A, Farges O, Goharin A, Le Mee J, Belghiti J . Output of chyle as an indicator of treatment for chylothorax complicating oesophagectomy. Br J Surg. 1998; 85(8):1147-9. DOI: 10.1046/j.1365-2168.1998.00819.x. View

20.

Backer C, LoCicero 3rd J, Hartz R, Donaldson J, Shields T . Computed tomography in patients with esophageal perforation. Chest. 1990; 98(5):1078-80. DOI: 10.1378/chest.98.5.1078. View