title: Synchronous perforations of the oesophagus and stomach by air insufflation: an uncommon complication of endoscopic dilation.
abstract: A 72-year-old woman had a history of carcinoma of the hypopharynx treated by total laryngectomy, circumferential pharyngectomy and free jejunal graft. Endoscopic dilation of the pharyngojejunal anastomotic stricture resulted in synchronous perforations of the oesophagus and stomach. We postulate that the perforations were caused by high intraoesophageal and intragastric pressure resulted from air insufflation during the procedure; in a situation simulating closed-loop obstruction, because of proximal obstruction by the endoscope at the stricture site and distal obstruction by pylorospasm. The sites of perforations were inherent points of weakness at the left side of the distal oesophagus and at the high lesser curve of stomach. Satisfactory outcome of our patient was attributed to prompt diagnosis and surgical repair. Endoscopists should be aware of this possibility during oesophagogastroduodenoscopy and dilation. Rapid and over insufflation of air should be avoided.
authors: Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors: Arthur M
authors: AM
authors: Fung
authors: Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors: Fion S
authors: FS
authors: Chan
authors: Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors: Ian Y
authors: IY
authors: Wong
authors: Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors: Simon
authors: http://orcid.org/0000-0002-6518-5806
authors: S
authors: Law
mesh_terms: D000368:Aged; D000388:Air; D003952:Diagnostic Imaging; D016099:Endoscopy, Gastrointestinal; D004940:Esophageal Stenosis / Q000209:etiology* / Q000628:therapy*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D006801:Humans; D007327:Insufflation / Q000009:adverse effects*; D013270:Stomach / Q000000981:diagnostic imaging / Q000293:injuries*