Iatrogenic pyriform sinus perforation during endoscopic ultrasonography

Abstract

A 65-year-old women underwent endoscopic ultrasonography (EUS) to evaluate the gastric submucosal tumor. The EUS scope was inserted into the esophagus after two attempts. A neck computed tomography (CT) scan showed a pneumomediastinum and an air bubble deep in the neck, suggesting an esophageal rupture. The patient was hospitalized and maintained conservative treatment including broad-spectrum antibiotics and withholding oral feeding. Teaching Point: Endoscopists should consider an imaging modality when a patient complains of moderate to severe neck pain after an upper endoscopy. Prompt surgical management should be considered in patients with a delayed diagnosis (> 24 hours), those with signs of systemic toxicity, and those who have eaten between the time of the procedure and when the perforation was detected.

Ingested fish bone causing cervical esophageal perforation with evaluation of critical anatomy by CT: A case report

“…Among 79 cases with esophageal rupture collected in a single institute, 39 sized of rupture > 10 mm underwent primary surgical repair and 4 patients died. In addition, mortality rate reached to 20% when causes were iatrogenic such as endoscopic procedures [5] , [6] , [7] . The mortality of esophageal perforation or rupture ranges between 10% and 20% unless an optimal treatment is undertaken within 48 hours since the diagnosis.…”

Medical disputes related to advanced endoscopic procedures with endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography for the management of pancreas and biliary tract diseases

“…1,2 However, PB endoscopy has a potential risk of complications due to its demanding high-level skill to perform the procedures. [3][4][5] Therefore, to minimize adverse events (AEs) and secure patient safety during the procedures, certified endoscopists with sufficient training are essential for PB endoscopy. 6,7 In addition, nurses and techni-cians who have a full understanding of operating processes and instruments also have an important role in effective endoscopic assistance.…”