Cervical esophagostomy for application of intraluminal negative pressure therapy

Abstract

Objective: Esophageal perforation is a very serious condition carrying a mortality rate of 10–25%. Historically, primary treatment was an open approach, but over the last two decades minimally invasive treatments have been employed. Intraluminal negative pressure wound therapy has shown promise for esophageal perforation. We present a case of intraluminal negative pressure therapy through a novel approach. Method: Case report. Results: A 55 year old male presented in respiratory distress and intubated for airway protection. Outside hospital computerized tomography (CT) scan showed evidence of esophageal perforation. He underwent an esophageal stent placement by gastroenterology for a distal perforation. After extubation on hospital day (HD) 4, he did not tolerate his nasogastric (NG) tube and it was removed. His perforation failed to close despite stent placement, mediastinal drains and chest tubes. On HD#16 his swallow study showed persistent perforation, but the patient adamantly refused having an NG tube placed for decompression. On HD#17 a left sided cervical esophagostomy was performed in the operating room through a lateral neck incision. A wound vac sponge sutured to an NG tube was placed through the esophagostomy and advanced to the site of the perforation under fluoroscopic guidance. This was connected to continuous low suction. The sponge was changed weekly through the esophagostomy without difficulty. On HD#31 the leak had resolved and the sponge was removed. The esophagostomy was closed at bedside. Conclusion: Esophagostomy offers safe access for intraluminal negative pressure therapy for esophageal perforations.

Keywords

• Esophageal perforation
• Esophagostomy
• Negative pressure therapy