PMC6487369_01
Diagnosis progress.. A. Chest x-ray - left pleural effusion.. B. CT scan - pneumomediastinum, left collapse lung and heterogeneous pleural effusion.. C. Chest tube drainage - food residue.
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Chest x-ray showed a large left pleural effusion (Fig. 1A). A CT scan was performed and revealed pneumomediastinum, left collapsed lung and loculated pleural effusion (Fig. 1B). A left intercostal chest tube (32 Fr) was inserted with residue food drainage (Fig. 1C).
Emergent left thoracotomy.. A. Debridement and drainage of the pleural space and mediastinum.. B. T-tube oesophageal drainage.
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Intraoperatively a collapsed left lung was found with large amounts of food material (Fig. 2A) and a 2.5 cm longitudinal tear on the left-lower oesophagus was identified. T-tube was positioned and sutured to the oesophageal perforation (Fig. 2B) in order to create a controlled fistula.
2nd look thoracotomy - oesophageal closure and pleural patch.
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Forty-eighth hours later, a second look thoracotomy was undertaken with further lavage and a definitive oesophageal repair - 3/0 monofilament interrupted sutures reinforced by using a pleural patch (Fig. 3).
Final outcome.
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On 3 months follow-up consultation, the patient is well with no impairments (Fig. 4).