TY - JOUR
T1 - Circumferential esophageal perforation resulting in tension hydropneumothorax in a patient with septic shock
AU - Saffo, Saad
AU - Farrell, James
AU - Nagar, Anil
N1 - Publisher Copyright:
© 2021 The Korean Society of Critical Care Medicine
PY - 2021/8
Y1 - 2021/8
N2 - Esophageal perforations occur traumatically or spontaneously and are typically associated with high mortality rates. Early recognition and prompt management are essential. We present the case of a 76-year-old man who was admitted to the medical intensive care unit with fulminant Clostridium difficile colitis, shock, and multi-organ failure. After an initial period of improvement, his condition rapidly deteriorated despite aggressive medical management, and he required mechanical ventilation. Radiography after endotracheal intubation showed interval development of pneumomediastinum and bilateral hydropneumothorax with tension physiology. Chest tube placement resulted in the drainage of multiple liters of dark fluid, and pleural fluid analysis was notable for polymicrobial empyemas. Despite the unusual presentation, esophageal perforation was suspected. Endoscopy ultimately confirmed circumferential separation of the distal esophagus from the stomach, and bedside endoscopic stenting was performed with transient improvement. Two weeks after admission, he developed mediastinitis complicated by recurrent respiratory failure and passed away. This report further characterizes our patient's unique presentation and briefly highlights the clinical manifestations, management options, and outcomes of esophageal perforations.
AB - Esophageal perforations occur traumatically or spontaneously and are typically associated with high mortality rates. Early recognition and prompt management are essential. We present the case of a 76-year-old man who was admitted to the medical intensive care unit with fulminant Clostridium difficile colitis, shock, and multi-organ failure. After an initial period of improvement, his condition rapidly deteriorated despite aggressive medical management, and he required mechanical ventilation. Radiography after endotracheal intubation showed interval development of pneumomediastinum and bilateral hydropneumothorax with tension physiology. Chest tube placement resulted in the drainage of multiple liters of dark fluid, and pleural fluid analysis was notable for polymicrobial empyemas. Despite the unusual presentation, esophageal perforation was suspected. Endoscopy ultimately confirmed circumferential separation of the distal esophagus from the stomach, and bedside endoscopic stenting was performed with transient improvement. Two weeks after admission, he developed mediastinitis complicated by recurrent respiratory failure and passed away. This report further characterizes our patient's unique presentation and briefly highlights the clinical manifestations, management options, and outcomes of esophageal perforations.
KW - Esophageal perforation
KW - Hydropneumothorax
KW - Septic shock
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U2 - 10.4266/ACC.2020.01067
DO - 10.4266/ACC.2020.01067
M3 - Article
AN - SCOPUS:85114809415
SN - 2586-6052
VL - 36
SP - 264
EP - 268
JO - Acute and Critical Care
JF - Acute and Critical Care
IS - 3
ER -