title: [Perforation of the esophagus after esophageal manometry].
abstract: METHODS
  A 75-year-old man was admitted for oesophageal manometry because of dysphagia for the past 2 years and retrosternal burning sensation unrelated to exercise. His general condition was appropriate for his age.
  
  
  METHODS
  An oesophagogram showed corkscrew-like deformation of a diffuse oesophageal spasm. The first, but incomplete, manometry recorded clearly propulsive contractions with markedly raised and prolonged pressure, as in "nutcracker oesophagus". The lower oesophageal sphincter could not be demonstrated initially. Subsequent pH measurements provided no evidence for increased gastrooesophageal reflux.
  
  
  METHODS
  After the first manometry conservative treatment was initiated with molsidomine, nifedipine and nitrospray sublingual, but the dysphagia was not significantly improved. A second manometry was performed before a planned surgical exploration. Placing of the catheter was again difficult and mild resistance experienced. Endoscopy revealed only minimal, presumably superficial, mucosal lesions. 2 days later bilateral pleural effusions together with mediastinitis occurred. Conservative treatment was continued until finally a distal oesophageal perforation was demonstrated. At surgery the perforation was seen and a oesophagectomy with gastric pull-through and intrathoracic anastomosis performed. However, the patient died of septic multi-organ failure.
  
  
  CONCLUSIONS
  Oesophageal manometry is a safe but invasive method with few complications for measuring oesophageal motility. Although this has not previously been reported, oesophageal perforation with mediastinitis may end fatally, if the particular circumstances are unfavourable. In addition to special anatomical features, type and state of the manometric catheter may present a risk factor.
authors.affiliation: Abteilung für Gastroenterologie und Hepatologie Berufsgenossenschaftliche Klinken Bergmannsheil, Bochum.
authors.forename: V
authors.initials: V
authors.lastname: Meister
authors.forename: H
authors.initials: H
authors.lastname: Schulz
authors.forename: I
authors.initials: I
authors.lastname: Greving
authors.forename: M
authors.initials: M
authors.lastname: Imhoff
authors.forename: L D
authors.initials: LD
authors.lastname: Walter
authors.forename: B
authors.initials: B
authors.lastname: May
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology; D004939:Esophageal Perforation / Q000209:etiology* / Q000601:surgery; D015155:Esophageal Spasm, Diffuse / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D016629:Esophagectomy; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry / Q000009:adverse effects* / Q000295:instrumentation; D008480:Mediastinitis / Q000209:etiology; D008981:Molsidomine / Q000627:therapeutic use; D009543:Nifedipine / Q000627:therapeutic use; D011859:Radiography; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D008981:Molsidomine; D009543:Nifedipine