Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2015; 7(7): 123-127
Published online Jul 27, 2015. doi: 10.4240/wjgs.v7.i7.123
Delayed esophageal perforation occurring with endoscopic submucosal dissection: A report of two cases
Yasuhiro Matsuda, Naoki Kataoka, Tomoyuki Yamaguchi, Masafumi Tomita, Kazuki Sakamoto, Shinichiro Makimoto
Yasuhiro Matsuda, Naoki Kataoka, Tomoyuki Yamaguchi, Masafumi Tomita, Kazuki Sakamoto, Shinichiro Makimoto, Department of Surgery, Kishiwada Tokushukai Hospital, Osaka 596-8522, Japan
Author contributions: Matsuda Y designed the report and wrote the paper; Kataoka N, Yamaguchi T, Tomita M, Sakamoto K and Makimoto S provided treatment.
Supported by The Department of Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan.
Institutional review board statement: The study was reviewd and approved by the Institutional Tewiew Borad of Kishiwada Tokushukai Hospital for ethical issues.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yasuhiro Matsuda, MD, Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-chou, Kishiwada City, Osaka 596-8522, Japan. my-salsa@air.ocn.ne.jp
Telephone: +81-72-4459915 Fax: +81-72-4459791
Received: February 26, 2015
Peer-review started: February 27, 2015
First decision: April 27, 2015
Revised: May 26, 2015
Accepted: June 9, 2015
Article in press: June 11, 2015
Published online: July 27, 2015
Abstract

We report two cases of delayed esophageal perforation occurring with endoscopic submucosal dissection. Our cases involved delayed perforation after 10 d in case 1 and after 6 d in case 2. Both cases were related to solid food. We performed subtotal esophagectomy with gastric tube reconstruction of the esophagus via the subcutaneous route anterior to the thoracic wall without conservative treatment because both cases involved chest pain and major leakage of food into the mediastinum. Postoperative complications were a local factor (including suture failure and esophageal stricture) in case 1, and we performed endoscopic balloon dilatation five times for esophageal stricture. There was no intrathoracic and mediastinal infection in either case. Surgical treatment for delayed esophageal perforation can be performed safely and surely if diagnosis and assessment are not delayed.

Keywords: Esophageal cancer, Endoscopic submucosal dissection, Delayed perforation

Core tip: Patients with early esophageal cancer often experience endoscopic submucosal dissection with complications, including bleeding, perforation, and stenosis. Although most cases are successfully treated conservatively, perforation is a life-threatening complication and can require surgical intervention. In our cases, we performed surgery approximately three hours after the patients’ complaints. Postoperative complications were a local factor (including wound infection and esophageal stricture) and did not include intrathoracic and mediastinal infection. Surgical treatment for delayed esophageal perforation can be performed safely and surely if diagnosis and assessment are not delayed.