University of Florida College of Medicine-Jacksonville Jacksonville, FL, United States
Radhika Sharma, DO, Lauren Stemboroski, DO, Bruno D. Ribeiro, MD University of Florida College of Medicine-Jacksonville, Jacksonville, FL
Introduction: Esophageal perforation is a serious complication of transesophageal echocardiography (TEE). Although extremely rare, perforations of the esophagus can lead to life-threatening complications with high morbidity and mortality. We present a unique case of esophageal perforation in a patient with no history of esophageal pathology, documented prior well-tolerated TEEs, and no clinical signs or symptoms of perforation peri or post procedure.
Case Description/Methods: A 79 year-old female with multiple comorbidities including hypertension, moderate aortic stenosis, chronic atrial fibrillation with a 27mm Watchman device presented to the ED for chest pain, shortness of breath, nausea, and vomiting. The patient was discharged earlier that morning after a post-Watchman TEE was performed. During the procedure, the probe was passed without difficulties and no peri-procedural complications were documented. Post-procedure, the patient had no complaints and was able to tolerate oral intake.
After arriving home, the patient began to experience severe substernal pain and throat irritation and returned to the ED. Urgent chest radiography showed findings concerning for pneumomediastinum. Stat computed tomography (CT) revealed extensive supraclavicular soft tissue emphysema along with gas in the anterior and middle mediastinum; no definitive perforation was seen. An urgent esophagogastroduodenoscopy (EGD) was performed and confirmed a linear esophageal perforation 15 cm from incisors below the cricopharyngeus. Due to the unique location of the perforation, one Ovesco clip was deployed over the defect. The patient later developed respiratory failure and unfortunately expired within a week.
Discussion: Although TEEs have been safely used as a cardiac diagnostic and monitoring modality, complications can occur. Esophageal perforations are attributed to increased mucosal pressure and thermal damage to the esophageal wall. Absolute contraindications include severe dysphagia and history of esophageal disorders. Risk factors for TEE-associated perforations include patient’s advanced age, multiple comorbidities, and an enlarged left atrium which can cause thinning of the esophageal wall. This case ultimately highlights the serious morbidity and mortality associated with post-TEE esophageal perforations. It is crucial that appropriate screening is done to identify high-risk individuals before such procedures are done.
Disclosures: Radhika Sharma indicated no relevant financial relationships. Lauren Stemboroski indicated no relevant financial relationships. Bruno Ribeiro indicated no relevant financial relationships.
Radhika Sharma, DO, Lauren Stemboroski, DO, Bruno D. Ribeiro, MD. P0444 - An Unexpected Case of Esophageal Perforation Following Transesophageal Echocardiography, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.