Case Report
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World J Gastroenterol. Sep 21, 2009; 15(35): 4461-4463
Published online Sep 21, 2009. doi: 10.3748/wjg.15.4461
Delayed presentation of intrathoracic esophageal perforation after pneumatic dilation for achalasia
Ming-Tzung Lin, Wei-Chen Tai, King-Wah Chiu, Yeh-Pin Chou, Ming-Chao Tsai, Tsung-Hui Hu, Chuan-Mo Lee, Chi-Sin Changchien, Seng-Kee Chuah
Ming-Tzung Lin, Wei-Chen Tai, King-Wah Chiu, Yeh-Pin Chou, Ming-Chao Tsai, Tsung-Hui Hu, Chuan-Mo Lee, Chi-Sin Changchien, Seng-Kee Chuah, Division of Hepatogastroenterology, Chang Gang Memorial Hospital, Kaohsiung 123, Ta-Pei Road, Niaosung Hsiang, Kaohsiung Country 833, Taiwan, China; Chang Gung University, College of Medicine, Kaohsiung 833, Taiwan, China
Author contributions: Lin MT wrote the paper; Lin MT, Tai WC, Chiu KW, Chou YP and Tsai MC contributed to this work by direct participation in the work, including substantial contributions to concept and design; Hu TH, Lee CM and Changchien CS revised the work critically for important intellectual content; Chuah SK designed, performed the work and revised it critically for important intellectual content.
Correspondence to: Seng-Kee Chuah, MD, Division of Hepatogastroenterology, Chang Gang Memorial Hospital, Kaohsiung 123, Ta-Pei Road, Niaosung Hsiang, Kaohsiung Country 833, Taiwan, China. chuahsk@seed.net.tw
Telephone: +886-7-7317123-8301 Fax: +886-7-7322402
Received: May 2, 2009
Revised: August 20, 2009
Accepted: August 27, 2009
Published online: September 21, 2009
Abstract

Pneumatic dilation (PD) is considered to be a safe and effective first line therapy for achalasia. The major adverse event caused by PD is esophageal perforation but an immediate gastrografin test may not always detect a perforation. It has been reported that delayed management of perforation for more than 24 h is associated with high mortality. Surgery is the treatment of choice within 24 h, but the management of delayed perforation remains controversial. Hereby, we report a delayed presentation of intrathoracic esophageal perforation following PD in a 48-year-old woman who suffered from achalasia. She completely recovered after intensive medical care. A review of the literature is also discussed.

Keywords: Intrathoracic esophageal perforation; Delayed presentation; Pneumatic dilation; Esophageal achalasia