Management of a life-threatening esophageal perforation during laparoscopic sleeve gastrectomy: a case study of an Ecuadorian patient

Esophageal perforation (EP) during laparoscopic sleeve gastrectomy is a rare but life-threatening complication. We report a case of a 46-year-old woman who developed late-onset EP, over 24 h postoperatively, following a sleeve gastrectomy, cholecystectomy, and hiatoplasty. The patient presented with epigastric pain, retrosternal discomfort, and dyspnea, and was diagnosed with a distal esophageal leak and mediastinitis. Surgical intervention included upper endoscopy, drainage tubes placement, thoracic and abdominal cavity lavage, and cervical esophagostomy. Postoperatively, the patient required intensive care for circulatory and ventilatory support, and antibiotic therapy was adjusted following positive culture results. Despite aggressive treatment, the patient remained in the intensive care unit for 12 days due to persistent systemic inflammatory response syndrome, but eventually recovered. This case emphasizes the importance of prompt diagnosis and management of EP in bariatric surgery. More research is needed to standardize treatment protocols for this rare but serious complication.