Oesophageal perforation following transoesophageal echocardiography: A case report on successful conservative management

• Published in: International journal of surgery case reports Vol. 61; pp. 161 - 164
• Main Authors: Rosly, Nadiah Binti, Loo, Guo Hou, Shuhaili, Mohamad Aznan Bin, Rajan, Reynu, Ritza Kosai, Nik
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-01-2019; Elsevier
• Subjects: Cardiopulmonary bypass; Cervical oesophagus; Oesophageal injury; TEE; Cardiopulmonary bypass; Oesophageal injury; Cervical oesophagus; TEE
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2019.07.039

•Transoesophageal echocardiography (TOE) is considered as a safe and non-invasive procedure.•Complications include odynophagia, upper gastrointestinal haemorrhage, endotracheal tube malpositioning and dental injury.•One of the rarer complications includes oesophageal perforation.•A high index of suspicion is crucial, particularly if there was a struggle in introducing the TOE probe.•Prompt diagnosis and vital investigations are crucial in order to advocate the early management of patients.•Conservative management may be worthwhile in a stable patient despite delayed presentation.
Transoesophageal echocardiography (TOE) is a widely used intraoperative diagnostic tool in cardiac patients, and it is considered as a safe and non-invasive procedure. However, it has its known complications, which is estimated to be 0.18% with mortality reported as 0.0098%.
Complications of TOE include odynophagia, upper gastrointestinal haemorrhage, endotracheal tube malpositioning and dental injury. One of the rarer complications includes oesophageal perforation, whose incidence is reported to be 0.01%.
We present a case of a 61-year-old lady with mitral valve prolapse (MVP) who underwent TOE with subsequent presentation of odynophagia with left neck swelling. An upper endoscopy examination was inconclusive; however, a contrasted computed tomography of the neck showed evidence of cervical oesophageal perforation. She was managed conservatively and discharged well.
The trauma caused by TOE probe insertion and manipulation accounts for most of the upper gastrointestinal complications. Mortality of patients associated with oesophageal perforation can be up to 20% and doubled if the treatment is delayed for more than 24 h. Mechanism of injury from TOE probe is likely multifactorial. Predisposing factors that increase the risk of tissue disruption include the presence of unknown structural pathology. Imaging studies and an upper endoscopy examination may aid in the diagnosis of oesophageal perforation.
A high index of suspicion, coupled with a tailored, multidisciplinary approach, is essential to achieve the best possible outcome. Conservative management may be worthwhile in a stable patient despite delayed presentation. Although TOE is considered a safe procedure, physicians should be made aware of such a dreaded complication.