Successful Late Management of Esophageal Perforation with T-Tube Drainage

Abstract

The late management of spontaneous esophageal perforation is the most challenging problem for the surgeon. In this paper, we present a case in whom a spontaneous esophageal perforation was successfully treated by T-tube drainage after unsuccessful conservative treatment. The patient, a 68-year-old male, was admitted to the hospital with sudden upper abdominal pain. After 2 days, esophageal perforation was diagnosed, and conservative management was begun. Thereafter, the subcutaneous emphysema disappeared, and the patient’s temperature decreased. However, on day 13, the patient’s temperature spiked above 38°C, and computed tomography showed a mediastinal abscess. An emergency left thoracotomy with laparotomy was performed. Since a 2-cm longitudinal perforation with severe inflammatory reactions was observed, the T-tube drainage method was performed. The patient was discharged without postoperative complications and has not experienced any gastrointestinal symptoms, such as gastroesophageal reflux or dysphagia. In conclusion, the T-tube drainage method appears to be a simple and effective method for the late management of esophageal perforation with severe inflammatory reaction.

Perforación esofágica espontánea Síndrome de Boerhaave. Caso clínico y revisión de la literatura

“…Una alternativa es la técnica utilizada en nuestro paciente, en el que se realizó la esofagorrafia sobre tubo en forma de T para generar una fístula controlada de esófago (6,10,11) . En este caso nos decidimos por esta técnica ya que se trataba de una lesión muy evolucionada, en la que no era planteable (por las características locales y la situación fisiológica del paciente) una rafia primaria, así como tampoco embarcarse en una esofagectomía, procedimiento de mucho mayor morbilidad (12)(13)(14) . El desarrollo posterior de la cirugía torácica videoasistida ha permitido la reparación primaria sin necesidad de toracotomía con buenos resultados.…”

T-tube placement as a method for treating penetrating oesophageal injuries

“…It has been shown to produce good results with many patients being salvaged by this method. There are reports of this method being applied with success in the setting of delayed presentation of penetrating injuries [17] , [18] .…”

Videocapsular endoscopy in the diagnosis of gastrointestinal diseases

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