]> 2026-07-31T10:04:35+00:00 WBR0263 0 en Placement of a nasogastric tube to the level of perforation, intravenous antibiotics, close observation and repeated esophagograms to confirm healing '''Incorrect'''-Placement of a nasogastric tube to the level of perforation, intravenous antibiotics, close observation and repeated esophagograms to confirm healing are conservative approaches for treating small perforations with a diameter of few millimeters without any diagnostic delay or septic symptoms. Gastrostomy Esophagectomy and esophagogastrostomy via laparotomy and left thoracotomy '''Incorrect'''-Only in distal perforations that are close to the gastroesophageal junction, a left thoracotomy approach is recommended. Esophagectomy and esophagogastrostomy via laparotomy and right thoracotomy '''Correct'''-Perforation of the esophagus requires aggressive intervention in virtually all circumstances. While that intervention can usually consist of efforts to patch the perforation and drain the mediastinum, concomitant obstructive esophageal disease, whether inflammatory stenosis or cancer, mandates removal or bypass of the obstruction if control of the leak and its consequent persisting mediastinal and pleural contamination is to be accomplished. For distal esophageal cancers, many thoracic surgeons would use the classic Ivor-Lewis operation, which consists of mobilizing the stomach in the abdomen and then performing a right thoracotomy with mediastinal drainage, esophagectomy, and esophagogastrostomy. Transhiatal esophagogastrectomy '''Incorrect'''-The transhiatal approach would probably be avoided in this situation where an unknown amount of mediastinal contamination has taken place. Inpatient Facilities Vendhan Ramanujam A 54 year old male was admitted following complaints of epigastric abdominal pain and dysphagia. Upon admission he looked pale and underweight. He was then followed by an upper gastrointestinal endoscopy for a possible distal esophageal cancer. After the procedure, he complains of significant new substernal pain. Palpation reveals subcutaneous emphysema. His temperature is 38 C, blood pressure is 110/68 mm Hg, respiratory rate is 20/min and heart rate is 112/min. Perforation of the esophagus is suspected. An immediate chest film reveals air in the mediastinum. Which of the following management is most recommended? D Gastrointestinal Surgery 2020-10-27T23:57:37Z 2459150.4983449 WBR0263