This case is unique in the use of minimally invasive techniques to manage a spontaneous esophageal perforation. Rather than perform thoracotomy, we elected to seal the esophageal leak by placing a self-expanding covered Polyflex stent with simultaneous video-thoracoscopic drainage and debridement. 1 The morbidity of the procedures was minimal and the patient's overall condition stabilized rapidly, allowing return to oral nutrition.Traditionally, identification of the perforation site at thoracotomy with debridement of nonviable tissue is necessary before a buttressed repair with wide drainage. 2 The success in the management of esophageal perforations depends on the time interval to intervention, the cause and the site of the perforation, and control of mediastinal contamination and restoration of esophageal continuity. 3 This case illustrates unique management of a spontaneous esophageal perforation by combining minimally invasive videoassisted thoracoscopic surgery with use of a flexible endoscope. Thoracoscopic drainage and debridement with upper endoscopy placement of a Polyflex stent sealed the esophageal perforation.The patient did well and eventually returned for outpatient stent removal.Spontaneous esophageal perforation may not require thoracotomy in all cases. In cases in which no underlying esophageal disease exists, a combination of upper endoscopy and thoracoscopy may allow adequate management of this patient population.
Cases of intrathoracic extrapulmonary hydatid cysts are very rare. We identified 13 patients with intrathoracic extrapulmonary hydatid cysts in our clinic over 12 years. Four patients had extrapulmonary cysts only; nine patients had both intrapulmonary and extrapulmonary cysts. Cysts were identified in the pleural space, extrapleural region, diaphragm and chest wall. Thoracotomy was used in all patients, and extrapulmonary lesions were removed by cyst extirpation from surrounding tissue or by pericystectomy.In one patient with chest wall involvement, partial rib resections were performed because of rib destruction. In two patients with liver cysts passing through the diaphragm to the thorax, the diaphragm was cut, cysts on the liver roof were removed and then the diaphragm was repaired. There was no mortality, morbidity, or disease recurrence during the post-operative period in any of the 13 patients. We conclude that these rare cases give a new insight into hydatid cyst pathophysiology.
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