Esophageal perforation after transesophageal echocardiography: A case report

INTRODUCTION: Esophageal perforation is a rare and severe complication following transesophageal echocardiography (TEE) that carries high morbidity and mortality rates. Management of these perforations usually requires complex open surgeries. We present the case of an esophageal perforation following TEE treated with a combined approach of upper endoscopy and left cervicotomy. PRESENTATION OF CASE: An 80 y/o male patient underwent a diagnostic TEE for mitral regurgitation. After discharge patient consulted back on the same day to the Emergency Department and a perforation of the cervical esophagus was diagnosed associated to an air-fluid collection in the mediastinum. The patient was treated with endoscopic closure of the perforation and left cervicotomy for mediastinal drainage. Patient was discharged home on POD 31 after full recovery. A written consent was previously obtained, and Institutional Review Board approval was not needed. DISCUSSION: Although not frequently seen, complications following TEE can be devastating if not diagnosed and treated early. Endoscopic closure of an esophageal perforation is a safe and feasible option with the already known advantages of a minimally invasive approach. Surgeons should have high suspicion if a patient present with characteristic symptoms after an uneventful procedure. CONCLUSION: Esophageal perforation is a very rare complication of TEE. High suspicion is mandatory to reach prompt diagnosis and install effective treatment. Primary closure of the perforation is the treatment of choice, and the endoscopic approach is a safe and feasible option in high volume centers.