Esophageal perforation

Case contributed by Dr Yung Howe Koh


Routine admission to ICU post TAVI procedure for severe aortic stenosis. He has a history of gastric leiomyoma with previous partial gastrectomy. The patient developed severe epigastric pain post TAVI. CT angiogram was performed to rule out dissection.

Patient Data

Age: 90 years
Gender: Male

Locules of gas insinuate throughout the posterior mediastinum, clustered around the inferior esophagus, tracking around the anterior and lateral margin of the aorta as well as layering over the medial diaphragm. Findings are most in keeping with a lower esophageal perforation.

Case Discussion

The patient underwent urgent transthoracic echocardiogram in the ICU to rule out complications from the TAVI procedure which was reported normal. His pain settled with IV Fentanyl however rebounded severely. It was then clear that the patient had developed a severe esophageal perforation secondary to routine transesophageal echocardiogram intraoperatively. 

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