Endoscopic Transnasal Drainage for Management of Iatrogenic Esophageal Perforation and Mediastinal Abscess
An 82-year-old woman suffered esophageal perforation during attempted
endoscopic retrograde cholangiopancreatography (ERCP). Following left
transcervical exploration and drainage, the patient remained septic with
free perforation into the mediastinum and resulting mediastinitis. This
video illustrates endoscopic discovery of perforated Zenker’s
diverticulum and endoscopic transnasal drainage of mediastinal abscess.
Sepsis
was controlled immediately following adequate endoscopic drainage.
Transnasal mediastinal drain was placed as was a percutaneous
gastro-jejunostomy for feeding. The patient was discharged home two
weeks later on a clear fluid diet. The transnasal Jackson-Pratt drain
was kept in place for 8 weeks following surgery. It was removed during
outpatient endoscopy and imaging confirmed resolution of the leak and
abscess.
References
- Lenzen H, Negm AA, Erichsen TJ, Manns MP, Wedemeyer J, Lankisch TO. Successful treatment of cervical esophageal leakage by endoscopic-vacuum assisted closure therapy. World J Gastrointest Endosc. 2013;5:340.
- Han
X, Zhao YS, Fang Y, Qi Y, Li X, Jiao D, et al. Placement of transnasal
drainage catheter and covered esophageal stent for the treatment of
perforated esophageal carcinoma with mediastinal abscess. J Surg Oncol. 2016;114:725–730.
- Altintoprak F, Gundogdu K, Eminler AT, Parlak E, Cakmak G, Uzunoglu Mustafa Y. An Endoscopic Nasomediastinal Approach to a Mediastinal Abscess Developing after Zenker’s Diverticulectomy. Case Rep Gastrointest Med. 2017;2017:8726706.
