Circumferential esophageal perforation resulting in tension hydropneumothorax in a patient with septic shock
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 difficil...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Korean Society of Critical Care Medicine
2021-08-01
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| Series: | Acute and Critical Care |
| Subjects: | |
| Online Access: | http://www.accjournal.org/upload/pdf/acc-2020-01067.pdf |
| _version_ | 1818738483314819072 |
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| author | Saad Saffo James Farrell Anil Nagar |
| author_facet | Saad Saffo James Farrell Anil Nagar |
| author_sort | Saad Saffo |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-18T01:09:39Z |
| format | Article |
| id | doaj.art-e3119ebc133945c386408a66abbaa2a3 |
| institution | Directory Open Access Journal |
| issn | 2586-6052 2586-6060 |
| language | English |
| last_indexed | 2024-12-18T01:09:39Z |
| publishDate | 2021-08-01 |
| publisher | Korean Society of Critical Care Medicine |
| record_format | Article |
| series | Acute and Critical Care |
| spelling | doaj.art-e3119ebc133945c386408a66abbaa2a32022-12-21T21:26:09ZengKorean Society of Critical Care MedicineAcute and Critical Care2586-60522586-60602021-08-0136326426810.4266/acc.2020.010671290Circumferential esophageal perforation resulting in tension hydropneumothorax in a patient with septic shockSaad Saffo0James Farrell1Anil Nagar2 Department of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA Department of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA Department of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USAEsophageal 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.http://www.accjournal.org/upload/pdf/acc-2020-01067.pdfesophageal perforationhydropneumothoraxseptic shock |
| spellingShingle | Saad Saffo James Farrell Anil Nagar Circumferential esophageal perforation resulting in tension hydropneumothorax in a patient with septic shock Acute and Critical Care esophageal perforation hydropneumothorax septic shock |
| title | Circumferential esophageal perforation resulting in tension hydropneumothorax in a patient with septic shock |
| title_full | Circumferential esophageal perforation resulting in tension hydropneumothorax in a patient with septic shock |
| title_fullStr | Circumferential esophageal perforation resulting in tension hydropneumothorax in a patient with septic shock |
| title_full_unstemmed | Circumferential esophageal perforation resulting in tension hydropneumothorax in a patient with septic shock |
| title_short | Circumferential esophageal perforation resulting in tension hydropneumothorax in a patient with septic shock |
| title_sort | circumferential esophageal perforation resulting in tension hydropneumothorax in a patient with septic shock |
| topic | esophageal perforation hydropneumothorax septic shock |
| url | http://www.accjournal.org/upload/pdf/acc-2020-01067.pdf |
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