PMC9758521_01
Preoperative findings.. A) Contrast-enhanced computed tomography scan showed a 30 x 25 mm encapsulated fluid retention in the mediastinum (closed arrow) and a bubble near the esophagus (crossed arrowhead).. B) Upper gastrointestinal endoscopy revealed a fistula at the 2 o'clock position, 30 cm from the incisor (closed arrow).
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CT scan revealed a mediastinal abscess (Fig. 1A), and intravenous antibiotic therapy was initiated. Considering that her blood test findings did not improve, on the fourth day of hospitalization we performed upper gastrointestinal endoscopy, which revealed perforation of the esophagus (Fig. 1B), and emergency surgery was planned.
PMC9758521_02
Preoperative findings.. A) The mid-thoracic esophagus was torn, the continuous gas image from the perforation site was encapsulated, and mediastinal emphysema was localized (closed arrowhead).. B) Upper gastrointestinal endoscopy revealed a large esophageal ulceration, 0-6 o'clock, 30-33 cm from the incisor tooth. The ulcer was perforated at the 4 o'clock position, and its tip was suspected to have reached the right mediastinal pleura (closed arrow).
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CRP level of 11.4 mg/dL. CT showed pleural effusion in the right lung, disruption of the mid-thoracic esophagus, and localized mediastinal emphysema (Fig. 3A). Upper gastrointestinal endoscopy revealed a sizeable esophageal ulcer 30-33 cm from the incisor (Fig. 3B).