LATE PRESENTATION OF ISOLATED ESOPHAGEAL PERFORATION AFTER FALL: CONSERVATIVE MANAGEMENT sejalgrover98@gmail.com

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LATE PRESENTATION OF ISOLATED ESOPHAGEAL PERFORATION AFTER FALL: CONSERVATIVE MANAGEMENT

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India

Oral or Poster

Esophageal perforation due to blunt trauma is an exceedingly rare entity, with the most comprehensive reviews accounting for less than 100 reported cases. Esophageal perforation by any etiology is considered life-threatening, and carries a mortality rate estimated from 18% to 48%.There are less than 10 cases of esophageal perforation reported due to fall, and none of them were isolated in nature. All of them were associated with severe vertebral and other fractures.

Our patient was a young male, with a history of accidental fall from height 2 weeks before presentation. Patient had no complaints immediately after the fall. Patient complained of breathlessness 2 weeks later, X-Ray was suggestive of air- fluid level in left hemithorax (Fig. 1), and an Intercostal drainage tube was inserted, draining pus. HRCT was suggestive of a sealed- off esophageal perforation (Fig. 2). OGDscopy guided clipping of perforation site, with Naso-jejunal tube insertion was done. Thereafter, CT- guided pigtailing of collection was done. Patient was discharged with nasojejunal tube in-situ, which was removed after 1 month.

Upon review after 6 months, patient is symptom-free and radiography shows no residual collection.

Esophageal perforation due to any cause is associated with high morbidity and mortality. In the setting of blunt trauma, perforation is extremely rare, but failure or delay of the diagnosis can have devastating consequences. For patients who have contained ruptures and show no clinical signs of sepsis, a trial of conservative management may be successful in healing the esophagus.