Case Report
Copyright ©2009 Baishideng. All rights reserved.
World J Gastrointest Surg. Nov 30, 2009; 1(1): 65-67
Published online Nov 30, 2009. doi: 10.4240/wjgs.v1.i1.65
Esophagectomy for a traumatic esophageal perforation with delayed diagnosis
Alexandre Zanchenko Fonseca, Marcelo Augusto Fontenelle Ribeiro Jr, Mariana Frazão, Maurício Campanelli Costas, Lanes Spinelli, Orlando Contrucci
Alexandre Zanchenko Fonseca, Marcelo Augusto Fontenelle Ribeiro Jr, Mariana Frazão, Maurício Campanelli Costas, Lanes Spinelli, Orlando Contrucci, Department of General Surgery, University of Santo Amaro, São Paulo-SP, CEP 04601-060, Brazil
Author contributions: Fonseca AZ, Ribeiro Jr MAF, Frazão M performed the research and wrote the paper; Fonseca AZ, Costas MC, Spinelli L, Contrucci O, Ribeiro Jr MAF operated on the patient.
Correspondence to: Alexandre Zanchenko Fonseca, MD, Department of General Surgery, University of Santo Amaro; Rua Rita Joana de Souza, 42 - Campo Belo, São Paulo-SP, CEP 04601-060, Brazil. azfonseca@hotmail.com
Telephone: +55-11-50446235 Fax: +55-11-32846892
Received: July 2, 2009
Revised: July 16, 2009
Accepted: July 23, 2009
Published online: November 30, 2009
Abstract

Esophageal perforations are rare, and traumatic perforations are even more infrequent. Due to the rarity of this condition and its nonspecific presentation, the diagnosis and treatment of this type of perforation are delayed in more than 50% of patients, which leads to a high mortality rate. An 18-year-old male patient was brought to the emergency room with a penetrating neck injury, caused by a gunshot wound. He was taken to the operating room and underwent surgical exploration of the neck and a chest tube was inserted to treat the hemo- and pneumothorax. During the procedure, a 2 cm lesion was detected in the esophagus, and the patient underwent a primary repair. A contrast leakage into his right hemithorax was noticed on the 4th postoperative day; he was submitted to new surgery, and a subtotal esophagectomy and jejunostomy were performed. He was discharged from the hospital in good condition 20 d after the last procedure. The discussion around this topic focuses on the importance of the timing of diagnosis and the subsequent treatment. In early diagnosed patients, more conservative therapeutics should be performed, such as primary repair, while in those with delayed diagnosis, the patient should be submitted to more aggressive and definitive treatment.

Keywords: Delayed perforation treatment; Diagnosis; Esophageal perforation; Esophageal trauma