Case on Iatrogenic Esophageal Perforation

Abstract

A 62-year-old male patient had been operated on because of a mitral stenosis. The valve had been replaced through a sternotomy. Postoperatively, the patient was admitted to the intensive care department, and there he developed a respiratory infection with respiratory insufficiency. The patient was treated by mechanical ventilation and antibiotics. After a period of 4 weeks, he still could not be disconnected from the mechanical ventilator and in order to rule out an insufficiency of the new implanted valve, a cardiac trans-esophageal ultrasound was performed. The valve was found to work correctly, but the patient’s low-grade sepsis persisted, which impeded weaning him from mechanical ventilation. The CT scan showed mediastinitis with free air in the mediastinum and a suspicion of a right thoracic empyema (Figs. 10.1 and 10.2). To rule out an esophageal perforation, an esophagoscopy was performed showing an esophageal perforation at 30 cm of incisors line.