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Abstract
Overtube provides a conduit for the passage of endoscope into the digestive tract. Esophageal perforation with mediastinitis is a rare overtube-related complication. Until now, no reports have been published regarding the esophageal perforation which developed many months after the original procedure using the overtube. A 56-year-old female visited our hospital complaining of chest pain and back pain that began 14 days ago. The patient underwent esophageal variceal ligation using the overtube 12 months earlier. She was diagnosed with esophageal perforation with mediastinitis which extended to intervertebral and epidural space. The cause of this condition was considered to have been related to the use of overtube. Management of delayed perforation remains controversial. Although surgical management might be the preferred mode of treatment, she underwent local N-butyl 2-cyanoacrylate injection therapy and temporary stent therapy with antibiotics due to high operative risk. Herein, we report a case of overtube-related delayed esophageal perforation with mediastinitis that was successfully treated by nonoperative management.
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Fig. 1.
Endoscopic findings. (A) Endoscopic elastic band ligation for active variceal hemorrhage was performed 12 months ago. (B) Follow-up endoscopy at 3 month after the procedure revealed small esophageal diverticulum at the ligation site. (C) Follow-up endoscopic finding at admission showed esophageal fistula (arrowhead) on mid-esophagus.
Fig. 2.
MRI findings. (A) Posterior mediastinal inflammatory mass that extends to intervertebral and epidural space can be seen (arrowheads). (B) Follow-up MRI taken after 4 months of treatment shows markedly decreased extent of posterior mediastinal inflammatory lesion.
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