Vacuum aspiration therapy in perforation of the esophagus and piriform sinus

Background. Perforation of the esophagus and piriform sinus is a potentially life-threatening condition that requires an interdisciplinary approach. To date, the minimally invasive method of treating this pathology is vacuum therapy. Based on recently published data, endoscopic vacuum therapy may be the main organ-preserving and effective method of treating esophageal perforation. In this clinical case, the technique and experience of perforation therapy in a patient with an undesirable phenomenon after treatment of non-epithelial formation of the esophagus by submucosal tunnel endoscopic resection are described. Objective. To improve the results of treatment of patients with perforation of the esophagus and piriform sinus using the negative pressure method as the main stage of surgery. Material and methods. A patient was admitted to the Botkin State Clinical Hospital as planned to perform endoscopic surgery for non-epithelial formation of the esophagus. Extraction of fragments of the formation was complicated by an undesirable phenomenon, in the form of perforation of the esophagus and pear-shaped sinus. Results. Taking into account the localization of the defect — the upper third of the esophagus, the pear-shaped sinus and the size of the fistula — 4.0 cm, the patient underwent a course of endoscopic vacuum therapy on the day of visualization of the perforation (on the third day after surgery). A polyurethane sponge with open pores was placed inside the organ, covering the defect area. The endoscopic treatment performed using the vacuum aspiration method led to the closure of the defect and showed the advantage of this method in the treatment of esophageal perforations. Conclusion. This clinical case confirms the high efficiency of treatment of acute iatrogenic perforation of the esophagus and piriform sinus by endoscopic vacuum therapy. Timely initiation of treatment is crucial for restoring the integrity of the wall in the area of post-traumatic defect, preventing the development of mediastinitis and purulent-septic complications.