P0367 - Management of Large Esophageal Perforation: When Surgery Is Not an Option

Subash Ghimire, MD¹, Vrushali Pachpande, MD¹, Rasmita Budhathoki, MD², Hafiz M. Khan, MD^3
1Guthrie Robert Packer Hospital, Sayre, PA; ²University of Miami, Jackson Memorial Hospital, Miami, FL; ³Guthrie/Robert Packer Hospital, Sayre, PA

Introduction: Esophageal perforation can lead to contamination of mediastinum, pleural effusion, and respiratory compromise. Although gold standard approach for management of esophageal perforation has been operative repair, esophageal stent placement is gaining popularity. This is particularly useful in patients who are poor surgical candidates. These stents can be used to treat even large esophageal defects. We describe the case of a 62-year-old male who underwent esophageal stent placement for management of malignant esophageal perforation.

Case Description/Methods: A 62-year-old male with past medical history of Invasive moderately differentiated adenocarcinoma of esophagus with metastasis to liver, lungs, and brain, treated with chemotherapy and radiation presented to the hospital with complaints of acute onset of sharp right-sided chest pain. Imaging revealed large right hydropneumothorax, atelectasis of right lung and distal esophageal perforation with mediastinitis (Figure A).

Patient underwent bronchoscopy and right video-assisted thoracoscopic surgery (VATS) with complete decortication. Post procedure, gastroenterology team was consulted for management of esophageal perforation. Esophagogastroduodenoscopy revealed large perforation (5 cm) of distal esophagus with ulceration in the adjacent mucosa at the site of tumor (Figure B). A 18 mm x 10.3 cm fully covered metal stent was placed under fluoroscopic guidance (Figure C). This procedure was performed for palliation and tamponade of the area of perforation from esophageal tumor resulting in hydropneumothorax and mediastinitis. Patient also underwent percutaneous jejunostomy tube placement for post pyloric feeding. Follow up esophagogram did not reveal extravasation of contrast into the mediastinum.

Discussion: Covered metallic stents can be successfully used for management of esophageal perforation and can be considered in patients who are otherwise poor candidates for surgery.



Disclosures:


Subash Ghimire, MD¹, Vrushali Pachpande, MD¹, Rasmita Budhathoki, MD², Hafiz M. Khan, MD³. P0367 - Management of Large Esophageal Perforation: When Surgery Is Not an Option, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.