Reinforced Primary Repair in Delayed Thoracic Esophageal Perforation

A 55-year-old man with severe right-sided empyema was admitted to our hospital. Six days before this admission, he had undergone upper GI endoscopy in another center to remove a retained chicken bone in lower esophagus and despite documented thoracic esophageal perforation, treatment was surprisingly delayed. The perforation was closed with primary sutures and reinforced with intercostal muscle flap wrap and pleural patch. Esophagography performed 3 weeks after the operation showed a well-healed esophagus without stenosis or leakage. We conclude that regardless of the time interval between the injury and the operation, reinforced primary repair is recommended for non-malignant thoracic esophageal perforation and provide a one-stage operation with preservation of the native esophagus. As far as we know, this type of procedure (with regard to its underlying infected body region and considerable controversy in delayed esophageal perforation management) has not been previously performed in Iran