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OBJECTIVE: Intrathoracic oesophageal perforation with empyema thoracis is a potentially life-threatening condition, which is conventionally managed by a thoraco-laparotomy. We hereby describe a novel minimally invasive approach for managing such cases
METHODS: Between April 2012 and October 2014, 3 male and 6 female patients with thoracic empyema resulting from oesophageal perforation underwent stenting of the perforation by endoscopic deployment of Self expanding Metallic Stents (SEMS) by our gastroenterologist. 48 hours later and after ascertaining no oesophageal leak, this was followed by a video assisted thoracoscopic (VATS) drainage of empyema and decortication
RESULTS: Oesophageal perforation was Iatrogenic in 4 patients, due to Boerhaves syndrome in 3, caustic ingestion in one and secondary to fish bone impaction in one. Leak from the Oesophageal perforation stopped after placement of SEMS in all patients except one, who had to undergo readjustment of stent 3 days later. VATS drainage of empyema and decortication was possible in all 9 patients. One patient had to be re-explored due to bleeding. There was no mortality. Mean chest drain dwell time post VATS was 4 days
CONCLUSIONS: Outcomes of intrathoracic oesophageal perforation and empyema are generally poor. Managing such complex cases by a combination of oesophageal stenting and VATS seems to be an effective approach in decreasing the morbidity and mortality