History: A 65-year-old patient underwent transesophageal echocardiography which caused a perforation of the upper esophagus. Three months after esophagostomy and gastrostomy the reconstruction was accomplished by a colon interposition graft. The patient postoperatively developed an ischemic necrosis of the graft, followed by a cervical fistula. Food intake and swallowing became impossible.
Diagnosis: X-ray examinations revealed the cervical fistula and a stenotic colon graft.
Treatment and course: The retrosternal colon graft was replaced by a gastric interposition graft, which was anastomosed with the cervical esophagus. The postoperative follow-up was normal at first. Increasing retention of secretion in the remaining esophagus however caused dilatation and a cervival fistula again, as well as a pleural empyema. After transthoracic resection of the esophagus the patient was finally free of symtoms, and gained weight on unrestricted food intake.
Conclusion: Transesophageal echocardiography is a common diagnostic procedure with a low complication rate. Even though serious complications may occur in rare cases, the patient must be informed about the risk. The perforation of the esophagus is an emergency situation that requires surgical treatment immediately. Primary reconstruction and preservation of the esophagus is the recommended strategy.