Patient with mediastinitis caused by delayed mucosal damage after peroral endoscopic myotomy

Peroral endoscopic myotomy (POEM) is a groundbreaking procedure for treating esophageal achalasia, and many reports from various facilities have described its safety and efficacy. However, there have been few reports on adverse events. Here, we report a case of a patient with mediastinitis caused by...

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Bibliographic Details
Published in:Asian journal of endoscopic surgery 2019-01, Vol.12 (1), p.107-110
Main Authors: Okada, Hiroki, Shiwaku, Hironari, Yamashita, Kanefumi, Ohmiya, Toshihiro, Inoue, Haruhiro, Hasegawa, Suguru
Format: Article
Language:English
Subjects:
Achalasia
Endoscopy
Esophageal Achalasia - surgery
Esophageal Sphincter, Lower - injuries
Esophageal Sphincter, Lower - surgery
Esophagus
Humans
Male
mediastinitis
Mediastinitis - diagnosis
Mediastinitis - etiology
Middle Aged
Mucous membrane
Mucous Membrane - injuries
Myotomy - adverse effects
Natural Orifice Endoscopic Surgery - adverse effects
Postoperative Complications - etiology
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Summary:Peroral endoscopic myotomy (POEM) is a groundbreaking procedure for treating esophageal achalasia, and many reports from various facilities have described its safety and efficacy. However, there have been few reports on adverse events. Here, we report a case of a patient with mediastinitis caused by delayed mucosal damage after POEM. This case was the most severe among all POEM cases at our hospital. A 58‐year‐old man had experienced dysphagia and chest tightness since he was around 50 years old. At a previous hospital, he had been diagnosed with nonerosive reflux disease and had undergone fundoplication. As his symptoms did not improve, he was referred to our department. POEM was able to be finished but a stable visual field could not be maintained throughout procedure because of strong esophageal contractions. From findings of endoscopy and esophagography after POEM, the patient was diagnosed mediastinitis caused by delayed esophageal perforation. In this case, conservative treatment (fasting, antibiotic therapy, and enteral feeding) was successful. However, the option to administer surgical treatment, such as drainage, must not be overlooked.
ISSN:1758-5902
1758-5910
DOI:10.1111/ases.12481