Pseudodiverticulum formation after iatrogenic esophageal perforation: a rare clinical course

Abstract

A 62-year-old man complained of fever and chest pain after undergoing transesophageal echocardiography (TEE). Computed tomography (CT) showed marked mediastinal emphysema and a defect of the right anterior wall of the lower thoracic esophagus. The patient was referred to our Department of Surgery to assess whether surgery was required. Non-surgical management was selected because the leakage of contrast was contained within the lower mediastinum on the esophagogram and there were no signs of sepsis. The fever and chest pain ameliorated promptly, while an esophagomediastinal fistula seemed to have formed and remained on repeated CT scans even 62 days after TEE. However, 65 days after TEE, esophagoscopy revealed that esophageal epithelium covered the entire fistula and a pseudodiverticulum had formed. Solid diet was started and the patient was discharged 69 days after TEE without any other complications. This case demonstrates that pseudodiverticulum formation is one of the clinical conditions that may occur after esophageal perforation.