Spontaneous Perforation of a Peptic Esophageal Stricture

Surgical interventions for intractable and unamenable for dilatation peptic esophageal strictures could sometimes be difficult and challenging. Esophageal perforation management depends on many factors such as underlying esophageal disease, location and cause of perforation, age, overall condition, comorbidities, and time from perforation to presentation. Of great importance for the selection of technique is whether the esophagus is normal and it is worthwhile trying not to remove it or whether it is pathologically changed and it is reasonable to proceed with resection during the initial intervention. We present a patient who has undergone surgery several times in another hospital for perforation of peptic stricture in the distal part of the esophagus and esophageal diversion in its proximal part. Three months later, he was admitted to the Thoracic Surgery Department and resection of the excluded esophagus followed by thoracic duct ligation for chylothorax was performed. After another three months, retrosternal colon replacement and subsequent removal of the gastrostomy were performed.