Iatrogenic esophageal traumas are the most common of
esophageal perforation, accounting for up to 60% of cases from which
endoscopic perforations are about 70%. Despite modern surgical
advanced techniques, perforation of the esophagus still represents
a true surgical emergency and this condition is associated with a
mortality of 20–30%. Early and accurate diagnosis and treatment of
esophageal injuries are critical. Indirect signs of esophageal injury
can be seen on a posteroanterior and lateral plain chest X-ray. Such
signs include pleural effusion, pneumomediastinum, subcutaneous
emphysema, hydrothorax, pneumothorax and collapse of the lung.
Computer Tomography (CT) of the chest and upper abdomen with
oral contrast can also show a leak and confirm the chest X-ray findings.
Three approaches are available for the treatment of esophageal
perforation: conservative, endotherapy, and surgery. Surgery is
mandatory in any part of the esophagus when the perforation is large
or when patients do not improve with conservative or endoscopic
treatment. We present our case who survived a massive thoracic
esophageal tear during endoscopic intragstric balloon insertion.
Emergency right thoracotomy was done; we found an inflated gastric
balloon perforating the thoracic esophagus and protruding in the
right thoracic cavity with a big longitudinal esophageal tear. The tear
was primarily repaired with suture of perforation with reinforcement
flaps. We conclude that; iatrogenic traumatic injuries of the esophagus
is rare but could be life threatening and must be managed by
multiple disciplinary teams. Urgent surgical esophageal repair is the
treatment of choice in big thoracic esophageal tears. This is the 1st
case documented with esophageal rupture due to intragastric balloon
insertion. |
