Esophageal Rupture and Mediastinitis Following Blakemore Tube Tamponade: A Cardiothoracic Emergency and Protocol-Based Prevention

The Sengstaken-Blakemore tube (SBT) is a balloon tamponade system employed as a temporary measure to achieve short-term hemostasis in patients experiencing uncontrolled bleeding from gastroesophageal varices. While these tubes are generally well-tolerated, they carry a risk of significant complications, including mucosal necrosis, aspiration pneumonia, esophageal perforation, and rebleeding after deflation of the balloon. Among these, esophageal perforation is a particularly rare but life-threatening complication that may result from improper placement or over-inflation of the balloon. This report presents a rare case of Blakemore tube-induced esophageal perforation, resulting from balloon misplacement, in a patient receiving treatment for variceal hemorrhage. The objectives of this case report are to highlight the potential for serious complications arising from improper tube placement and to provide guidance on preventing such incidents. This report emphasizes the need for monitoring of balloon tamponade devices and verification of proper tube positioning before and after the inflation of the gastric balloon, especially in emergency settings where rapid intervention is essential. By outlining the clinical presentation, diagnostic challenges, and treatment strategies in this case, we aim to enhance clinician awareness of the rare but serious risks associated with SBT use and provide practical guidance for minimizing complications, improving patient outcomes, and ensuring the safety and effectiveness of this life-saving procedure.