Rosly Nadiah Binti, Loo Guo Hou, Shuhaili Mohamad Aznan Bin, Rajan Reynu, Ritza Kosai Nik
Department of Surgery, Faculty of Medicine, The National University of Malaysia, Jalan Yaacob Latiff, Bandar Tun Razak, 56000, Selangor, Malaysia.
Int J Surg Case Rep. 2019;61:161-164. doi: 10.1016/j.ijscr.2019.07.039. Epub 2019 Jul 19.
Transoesophageal echocardiography (TOE) is a widely used intraoperative diagnostic tool in cardiac patients, and it is considered as a safe and non-invasive procedure. However, it has its known complications, which is estimated to be 0.18% with mortality reported as 0.0098%. Complications of TOE include odynophagia, upper gastrointestinal haemorrhage, endotracheal tube malpositioning and dental injury. One of the rarer complications includes oesophageal perforation, whose incidence is reported to be 0.01%.
We present a case of a 61-year-old lady with mitral valve prolapse (MVP) who underwent TOE with subsequent presentation of odynophagia with left neck swelling. An upper endoscopy examination was inconclusive; however, a contrasted computed tomography of the neck showed evidence of cervical oesophageal perforation. She was managed conservatively and discharged well.
The trauma caused by TOE probe insertion and manipulation accounts for most of the upper gastrointestinal complications. Mortality of patients associated with oesophageal perforation can be up to 20% and doubled if the treatment is delayed for more than 24 h. Mechanism of injury from TOE probe is likely multifactorial. Predisposing factors that increase the risk of tissue disruption include the presence of unknown structural pathology. Imaging studies and an upper endoscopy examination may aid in the diagnosis of oesophageal perforation.
A high index of suspicion, coupled with a tailored, multidisciplinary approach, is essential to achieve the best possible outcome. Conservative management may be worthwhile in a stable patient despite delayed presentation. Although TOE is considered a safe procedure, physicians should be made aware of such a dreaded complication.
经食管超声心动图（TOE）是心脏病患者术中广泛使用的诊断工具，被认为是一种安全的非侵入性检查。然而，它存在已知的并发症，据估计发生率为0.18%，死亡率为0.0098%。TOE的并发症包括吞咽痛、上消化道出血、气管导管位置异常和牙齿损伤。较罕见的并发症之一是食管穿孔，据报道其发生率为0.01%。
我们报告一例61岁患有二尖瓣脱垂（MVP）的女性患者，其接受了TOE检查，随后出现吞咽痛并伴有左颈部肿胀。上消化道内镜检查结果不明确；然而，颈部增强计算机断层扫描显示有颈段食管穿孔的迹象。她接受了保守治疗并康复出院。
TOE探头插入和操作引起的创伤是大多数上消化道并发症的原因。与食管穿孔相关的患者死亡率可达20%，如果治疗延迟超过24小时，死亡率会加倍。TOE探头造成损伤的机制可能是多因素的。增加组织破坏风险的易感因素包括存在未知的结构病变。影像学检查和上消化道内镜检查可能有助于食管穿孔的诊断。
高度的怀疑指数，结合量身定制的多学科方法，对于取得最佳结果至关重要。对于病情稳定的患者，尽管就诊延迟，保守治疗可能是值得的。虽然TOE被认为是一种安全的检查，但医生应意识到这种可怕的并发症。
