Iatrogenic perforation after ESD
- 42-year-old male
- ESD for Barrett’s esophagus with intramucosal cancer
- Perforation treated with VAC-Sponge
Medical history
- 2x kidney transplantation 1996
- PTLD (B-cell lymphoma) 2012, CHOP
- Cellulary immunodeficiency syndrome with no CD19 lymphocytes
- Immunosuppression with azathioprin, tacrolismus and prednisolon
- Creatinin: 570 mmol/l (N: 90), thrombocytopenia 50.000
8hours after ESD
- Acute dyspnoe and abdominal pain
- SIRS
CT-scan: pleural empyema and mediastinal air. Endoscopy: no signs of perforation.
Treatment
- Antibiotics i.v.
- Pleural drainage
- Initial improvement of respiration and inflammatory parameters
7days after ESD
- CT-scan and endoscopy were performed
Large defect at the ESD site, with contaminated mediastinal cavity.
Treatment with VAC-Sponge was initiated
Case with courtesy of prof. dr. Stefan Seewald, GastroZentrum Hirslanden Zürich