Esophageal perforation is a rare but life-threatening condition with high mortality. Iatrogenic injury and foreign body ingestion are the most common causes. While early primary repair is preferred for lesions diagnosed within 24 h, management depends on timing, location, and etiology, and may be surgical, endoscopic, or combined. A 65-year-old male presented with a 5-day history of dysphagia, cervical pain, and foreign body sensation after recent travel abroad. Contrast-enhanced CT and CT esophagography revealed a thoracic esophageal perforation with mediastinitis. Endoscopic extraction of a meat bone was unsuccessful, prompting right-sided thoracotomy. Intraoperative findings of gross mediastinal contamination contraindicated primary closure. Esophagectomy with proximal diversion was performed, including end cervical esophagostomy, gastric decompression via gastrostomy, and feeding jejunostomy. The postoperative course was complicated by empyema requiring pulmonary decortication. After two months in the ICU, the patient was discharged with nutrition via gastrostomy. Three months later, reconstruction was achieved using a retrosternal gastric conduit with esophagogastric anastomosis. Proximal esophageal diversion is indicated in cases of severe mediastinal contamination, with end cervical esophagostomy preserving maximal esophageal length for later reconstruction. This case highlights the importance of early diagnosis, as delayed recognition significantly limits conservative options and often necessitates staged surgical management.
Kováč et al. (2026) studied this question.