@article{oai:nagasaki-u.repo.nii.ac.jp:00021847,
 author = {Tomonari, Kazuhide and Uchida, Yuzo and Hadama, Tetsuo and Tanaka, Koichi and Shirabe, Joji and Fujitomi, Yutaka},
 issue = {1-4},
 journal = {Acta medica Nagasakiensia},
 month = {Oct},
 note = {Thanks to the improvement of the types of the endoscope and the progress of its techniques, the incidence of esophageal perforation has been decreasing recently. It should be pointed out, however, that esophageal perforation is a very serious iatrogenic disease requiring an early diagnosis and an adequate drainage in order to save the lives of patients. A woman at the age of 68 received gastrofiberscopical examination under suspicion of gastric ulcer, but immediately after the inspection, the patient had severe epigastric pain and dyspnea, and in five hours subcutaneous pneumatosis appeared on her neck. Chest X-ray pictures revealed mediastinal pneumatosis in high degree and pneumothorax on the left, and blood gas analysis showed the decrease in PO2 and the rise in PCO2. Since the patient fell into the state of shock, esophagography and esophagoscopy were not performed, but operation was given immediately. Hematoma was found at a site immediately above the diaphragm and on the left posterior wall, and abscess was formed in the mediastinum. We did not suture the injured region, but drinage of the mediastinum and the left thoracic cavity was given. After the operation, tracheostomy was performed, and her respiration was managed with a ventilator, simultaneously placing the nasogastric tube within the stomach to reduce the pressure inside it. In 15 days after operation, food intake was resumed, and in 46 days the patient was discharged in good health. Thus, it is important for esophageal perforation to give drainage as early as possible at a most appropriate position, which will enable us to same the patient in dyspnea and shock in esophageal perforation., Acta medica Nagasakiensia. 1988, 33(1-4), p.254-259},
 pages = {254--259},
 title = {Instrumental Perforation of the Esophagus A Case Report and Review of Literature},
 volume = {33},
 year = {1988}
}