Instrumental perforation of the esophagus.

Instrumental perforation of the esophagus occurred in a 55-year-old man who underwent esophagoscopy. The complication occurred when the esophagoscope broke during the procedure to remove a bolus of food. After the scope was withdrawn and examined, a defect was seen in its side where a weld on the light carrier had broken, causing a ribbon of mucosa and muscularis to be impinged in this defect. The esophagus was reexamined with a new esophagoscope. A nasogastric tube was passed into the stomach, and antibiotics were administered. Although the dangers of endoscopy are well documented and are decreasing, complications occur in up to 1% of the cases. Early diagnosis and prompt treatment, regardless of the site of perforation, continue to be the critical factors in reduction of the morbidity and mortality of this iatrogenic injury.