PMC5526513_01
a. At initial diagnosis, computed tomography scan revealed cervical subcutaneous emphysema. b. A large quantity of pleural fluid on the left side and mediastinal emphysema were detected.
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Mediastinal emphysema and a massive pleural effusion were observed on a plain chest CT scan (Fig. 1a, b).
At initial diagnosis, fluoroscopy indicated a perforation on the left side of the distal esophagus (arrow).
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Fluoroscopy with gastrografin showed an esophageal perforation approximately 1 cm in diameter (Fig. 2).
a. The laceration of the mucosa showed erythema and was accompanied by slight stiffness. b. Arrow shows the perforation site that was not closed.
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The site of perforation was visualized, surrounded by 3 cm of lacerated mucosa on the left side of the distal esophagus. (Fig. 3a, b).
a. We performed a contrast examination using gastrografin endoscopy and confirmed the perforation site. Arrow shows gastrografin that refluxed into the thoracic cavity. b. Although the mucosa was stiff, clipping could be performed. c. After clipping, there was no leakage of contrast. d. Follow-up endoscopy at six months after discharge shows two residual clips with no esophageal stenosis.
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Corporation, Tokyo, Japan) (Fig. 4b). Closure of the perforation was confirmed on a subsequent contrast study using gastrografin, which showed no leak (Fig. 4c). Follow-up endoscopy at six months after discharge showed in Fig. 4d.
The patient had an uneventful recovery. However, because of the rupture, further therapy was needed (e.g., treatment for Helicobacter pylori, bacterial culture before drain withdrawal) and the patient was hospitalized for 34 days. CRP: C-reactive protein.
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However, because of the rupture, further therapy was needed (e.g., treatment for Helicobacter pylori, bacterial culture before drain withdrawal) and the patient was hospitalized for 34 days (Fig. 5).