Esophageal perforation is a critical injury with high morbidity and mortality.
1
Higher mortality rates have been attributed to delays in diagnosis and management.
2
,
3
Despite numerous reports on a wide range of potential approaches to management, there
is still controversy as to the most effective therapy for esophageal perforation.
4
,
5
,
6
,
7
,
8
,
9
,
10
In particular, the management of a delayed perforation with mediastinitis remains
contentious and problematic.
7
,
9
Although aggressive operative therapy remains the treatment of choice,
7
,
8
,
9
nonoperative management consisting of parenteral nutrition and antimicrobial therapy
can be successful in selected patients.
4
,
5
,
6
,
10
,
11
For treatment of mediastinitis caused by esophageal perforation, transesophageal
irrigation with a nasogastric tube positioned endoscopically through the perforation
could potentially be effective; a few cases have been described in which this type
of endoscopic management was used.
11
Moreover, successful nonoperative therapy involving endoscopic closure of a perforation
with metallic clips has been reported.
12
However, nonoperative treatment for delayed esophageal perforation with mediastinitis
by endoscopic placement of a nasomediastinal drain and metal clip application has
not been described. This is a case of delayed esophageal perforation with mediastinitis
caused by ingestion of a foreign body that was successfully managed by using these
endoscopic techniques.To read this article in full you will need to make a payment
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References
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- Surgical management of late esophageal perforation.Thorac Cardiovasc Surgeon. 1997; 45: 269-272
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- Transesophageal drainage of the mediastinum in perforating mediastinitis.Vestn Khir Im I I Grek. 1983; 130 ([in Russian with English abstract]): 24-27
- Closure of an esophageal perforation due to fish bone ingestion by endoscopic clip application.Gastrointest Endosc. 2000; 51: 736-739
- Esophageal perforations: a 15-year experience.Am J Surg. 1982; 143: 495-502
Article info
Footnotes
☆Reprint requests: Nobutsugu Abe, MD, First Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo 181-8611, Japan.
Identification
Copyright
© 2001 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
