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Case Report
Circumferential esophageal perforation resulting in tension hydropneumothorax in a patient with septic shock
Saad Saffo, James Farrell, Anil Nagar
Acute Crit Care. 2021;36(3):264-268.   Published online March 11, 2021
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AbstractAbstract PDF
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.


Citations to this article as recorded by  
  • Current approach for Boerhaaves syndrome: A systematic review of case reports
    Ippei Yamana, Takahisa Fujikawa, Yuichiro Kawamura, Suguru Hasegawa
    World Journal of Meta-Analysis.2023; 11(4): 112.     CrossRef

ACC : Acute and Critical Care