Abstract
The number of reported cases of iatrogenic gastrointestinal perforation has been increasing with the spread of endoscopic treatment. A case of iatrogenic esophageal perforation that occurred during endoscopic submucosal dissection (ESD) is reported. The patient was a 62-year-old man who underwent ESD for esophageal cancer, 4 cm in diameter, in the middle to lower esophagus, which was found during a health check-up. Subcutaneous emphysema was observed immediately after the procedure, and CT revealed mediastinal emphysema and bilateral pneumothorax. The patient was referred to the Department of Surgery, where bilateral mediastinal and chest drainage was performed as emergency surgery. Oral ingestion was resumed on 8 POD after confirming the absence of leakage on esophagography. The drainage tube was removed on 12 POD, and the patient was discharged in good condition on 22 POD. While 80% of cases of esophageal perforation are iatrogenic, it will become a fatal complication if diagnosis or treatment is delayed, and the serection of conservative treatment or surgery is often difficult. The appropriate treatment for the present patient is discussed. Sufficient knowledge of the indications for conservative and surgical treatment is needed to facilitate suitable management.
