Primary Endoscopic Management of Esophageal Perforation Following Transesophageal Echocardiogram

Abstract

A 90-year-old woman sustained a proximal esophageal perforation following transesophageal echocardiography. The perforation originated at the site of a Zenker's diverticulum and resulted in a false passage to the diaphragm. Initial management involved endoscopic placement of drains into the mediastinum in addition to bilateral chest drains and a gastrostomy. Following stabilization, the patient had repair of her Zenker's diverticulum and recovered uneventfully. We recommend that all procedures involving blind intubation of the esophagus should be preceded with specific pursuit of a background of cervical dysphagia.

Esophageal Perforation: A Rare Complication of Transesophageal Echocardiography in a Patient with Asymptomatic Esophagitis

“…Contraindications to TEE include substantial dysphagia, severe instability of cervical vertebrae and esophageal disorders such as diverticulum, fistula, laceration, severe inflammation, stricture, tumor and varices [3]. Other perforation-cajoling factors may include advanced age and operator inexperience [1]. As highlighted in the case, asymptomatic severe esophagitis and advanced age may have contributed to perforation in our patient.…”

“…One of the most serious but rare complication of TEE is perforation of the esophagus. Such perforations continue to have high morbidity and mortality rates, with fearsome outcomes of mediastinitis, sepsis and multiorgan failure [1]. In a large series of 10,000 cases of TEE, esophageal perforation was reported in 3 cases (0.03%) with no mortalities [2].…”

Hypopharyngeal perforation during endoscopic ultrasound treated by primary repair

“…10 Specific management of a cervical esophageal perforation is described in a 90year-old woman after a TOE, with the perforation originating in a pharyngeal pouch. 11 This consisted of the endoscopic placement of mediastinal drains, bilateral tube thoracostomies, and a gastrostomy. Once the patient had been stabilized, the pouch was repaired and subsequent recovery was uneventful.…”

Oesophageal food impaction in achalasia treated with Coca-Cola and nifedipine

“…The use of carbonated beverages to treat food obstruction was first described in 1981 by Felson in a patient with achalasia and stenosing cancer 4. Others reported the use of carbonated soda water to dislodge oesophageal foreign bodies5 and the use of Coca-Cola in the management of bolus obstruction in benign oesophageal stricture 6. Fizzy drinks and sodium bicarbonate solutions7 penetrate the bolus and are thought to disintegrate it by releasing carbon dioxide, which in turn triggers relaxation of the LES so that the liquified bolus enters the stomach.…”