Abstract
A 74-year-old man underwent a total gastrectomy, partial resection of the lower esophagus via light thoracotomy, an intrathoracic esophagojejunal anastomosis, and Roux-en-Y reconstruction. Six months after surgery, he was admitted to the hospital because of dysphagia. Upper gastrointestinal endoscopy revealed an esophagojejunal anastomotic stricture. During the dilatation with an endoscopic balloon, the patient suddenly complained of chest pain and dyspnea. Mucosal injuries on the anastomosis were found, clinically suggesting an esophageal rupture. The left respiratory sound disappeared by auscultation with stethoscope. A chest CT scan revealed a left tension pneumothorax. Chest drainage was performed via the fourth intercostal space on the anterior axillary line, and the symptoms were reduced. After drainage for three weeks, the pneumothorax was improved, and the chest drainage tube removed. On the follow-up upper gastrointestinal endoscopy, the damaged mucosa on the anastomosis was restored, and the patient was able to ingest well. This case report indicated that the tension pneumothorax had been caused by an iatrogenic esophagus perforation after endoscopic balloon dilatation of the anastomotic stricture.
