PMC5403789_01
Pre-operative endoscopic and radiological findings. 1A: Endoscopic image demonstrating esophageal tear with two over the scope clips (OTSC). 1B: Esophagram showing persistent esophageal leak. Fig. 1C: CT scan showing esophageal stent migration into the stomach 1D: Primary repair of mucosal and muscular esophageal layers.
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Center, where endoscopic closure of the esophageal tear with two over the scope clips (OTSC) was attempted (Fig. 1a). Contrast study done the following day showed persistent esophageal leak (Fig. 1b). Despite an additional OTSC to hold the stent in position, the stent migrated into the stomach (Fig. 1c).
Simplified decision tree for management of thoracic esophageal perforation.
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After debridement of the mediastinum, the esophageal perforation was identified and OTSCs were removed (Fig. 2a). Necrotic tissue on mucosal and muscle edges was debrided; followed by primary closure with interrupted 4.0 polyglyconate, absorbable sutures (Maxon, Covidien, USA) closing both mucosal and muscular layers (Fig. 2b).