PMC7530227_01
Abrasions noted on initial physical examination.
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On exam, he had diffuse abrasions on his torso in the configuration of a square (Fig. 1).
a; Chest X ray showing pneumoperitoneum (yellow arrow) with air extending to the neck (red arrow), b: CT scan showing pneumomediastinum (yellow arrow), c: Pneumomediastinum (yellow arrow) and intraabdominal free fluid (asterisk).
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A chest x-ray was performed which showed pneumoperitoneum (Fig. 2a). CT scan revealed pneumomediastinum, pneumoperitoneum, and intraabdominal free fluid, particularly in the region of the esophageal hiatus (Fig. 2b and c).
Intraoperative picture showing complete GEJ separation (white arrow).
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Initial inspection during the laparotomy revealed gross contamination with food debris and a total gastroesophageal junction (GEJ) disruption (Fig. 3).
Final contrast study showing no contrast extravasation from the anastomosis and distal passage of contrast.
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On day 7, an esophagram showed no leak at the anastomosis and immediate stomach emptying (Fig. 4).