Thoracic esophageal perforation by the use of Magill forceps in infant, success with non-operative treatment: case report

Background Esophageal perforation is a rare surgical pathology in children. Thoracic esophageal perforation is more severe than cervical esophageal perforation. Iatrogenic cause, mainly by endoscopy, is the most common in esophageal perforation. However, perforation induced by “Magill forceps” is exceptional. Case presentation A systematic physical examination revealed pyrexia severe respiratory distress and right-sided pleural effusion. We report the success of non-operative treatment applied to thoracic esophageal perforation due to Magill forceps in a 24-month-old male infant. The immediate and short-term outcomes were excellent. Conclusions Non-operative treatment is possible in iatrogenic perforation of thoracic esophageal in infants. This treatment delivers excellent outcome in carefully selected patients.

806 CERVICAL ESOPHAGEAL PERFORATION: MULTIMODAL APPROACH TO A RARE AND MORBID CONDITION

Cervical esophageal perforation (CEP) is an uncommon but serious surgical condition. It is associated with a high morbidity and mortality if not managed timely, partly due to its close proximity with vital structures in the neck and mediastinum. The common causes include trauma, foreign body ingestion and iatrogenic perforation. The diagnosis and management of CEP remain challenging despite advances in surgery. Methods We present a series of 3 cases of CEPs, with multimodal approach for the management. Results In this series of 3 cases of CEPs with different presentations, tailored management strategies resulted with successful outcomes. Post-procedure/operative oral contrast study revealed no contrast leakage. Conclusion The diagnosis and management of CEP remain challenging despite advances in surgery. Contrasted CT scan and endoscopy are the mainstay of investigations. The treatment options of CEP range from conservative management to endoscopic intervention to surgical repair often with drainage procedures due to its frequent association with collections in the neck, pleural or mediastinal cavity. Prompt detection and early management with multimodal intervention ensure a better outcome in these patients.

Rare case of postoperative mediastinitis following thyroidectomy

Descending necrotizing mediastinitis (DNM) is a life-threatening complication secondary to oropharyngeal abscesses, cervical esophageal perforation, or neck infections spreading along the fascial planes into the mediastinum. Post-thyroidectomy surgical site infection is a highly unusual complication that is typically localized around the incision, but may be propagated into the mediastinum, causing DNM. We encountered a case of this rare complication after thyroidectomy. The patient was a 33-year-old woman who was admitted to our center for left hemithyroidectomy. The surgery was performed without any intraoperative events. However, she later developed fever, hypotension, and tachycardia. Imaging revealed deep neck emphysema and focal pneumomediastinum with infiltration in the anterior neck and mediastinum with abscess formation. Additional imaging at 7 days postoperatively revealed reduced fluid collection deep in the neck with minimal changes in fluid collection in the mediastinum. Esophageal perforation was excluded via an esophagogram, which lead to the conclusion that the infection may have been caused by open thyroidectomy. The patient was treated with prompt medical and surgical intervention. After treatment, she was discharged from the hospital with no further complications. We present our case report as well as a literature review of the diagnosis and treatment of this disease.