Esophageal perforations of any cause may escape early diagnosis and progress to lethal mediastinitis despite aggressive management. The treatment and outcome depends on the extent and chronicity of the injury.
A case report: We present a case of a late-diagnosed cervical esophageal rupture treated successfully with external vacuum therapy. A blunt trauma patient with cervical vertebral column fractures underwent fixation with a titanium bracket. A procedure-related esophageal perforation created an open fistulous communication to the skin. This was diagnosed with one month's delay. In diagnostic endoscopy the prosthesis was visible through a large esophageal defect. Evidence of mediastinitis was absent. The external wound was explored and a standard vacuum device was inserted. Nine weeks of continuous vacuum therapy achieved complete fistula closure and prevented infection. Mediastinitis was avoided and complete oral feeding was resumed.
Conclusions: Different clinical presentations indicate surgical, endoscopic or conservative treatment. In this report, we provide the ground for discussion for the alternative application of the vacuum technology in a case where otherwise surgery would be the definite treatment.
Keywords: esophageal perforation; esophagocutaneous fistula; mediastinitis; pleural effusion; vacuum therapy.
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