Page 81 - JSOM Fall 2025

FIGURE 1 Initial CT of chest showing large volume The patient was extubated on hospital day 4 and initially had
pneumomediastinum. some dysphagia and difficulty managing secretions; these were
managed with nasogastric decompression. Repeat CT imag-
ing on hospital day 8 showed proper positioning of the stent
(Figure 4), and 12 days after his injury the patient underwent
a fiberoptic endoscopic evaluation of swallowing and an
esophagram with no evidence of leak. The patient’s diet was
managed with total enteral nutrition via nasogastric tube until
hospital day 6 when he advanced to a clear liquid diet and
subsequently to a stent-appropriate diet. Notably, the patient
never required video-assisted thoracoscopic surgery since he
improved clinically on antibiotics and did not have evidence of
mediastinal or pleural collections on subsequent imaging. He
was discharged on hospital day 14 with oral antibiotics and a
follow-up appointment for stent removal.

FIGURE 4 CT esophagram with esophageal stent in place on
hospital day 8.

he was reintubated, and an esophagogastroduodenoscopy re-
vealed an esophageal perforation 22cm from the teeth (Figure
2). He subsequently underwent endoscopic stenting of the per-
foration with a self-expanding metal stent by gastrointestinal
medicine (Figure 3). The stent was placed 24 hours after the
injury. Following this, the patient was managed with IV anti-
biotics and antifungals for 7 days.

FIGURE 2 Visualization of esophageal injury on initial
esophagogastroduodenoscopy.

The patient re-presented to the emergency department 8 days
after discharge with concerns that his stent had migrated. CT
esophagram revealed that the stent was in a stable position
with no evidence of leak and he was discharged home. His
stent was removed 62 days after placement without issue.

Discussion
FIGURE 3 Chest CT with small paraesophageal collection This case demonstrates that early identification and local-
immediately after esophageal stent placement.
ization of esophageal perforations, coupled with successful
advanced endoscopic management, may greatly reduce mor-
bidity associated with these injuries. 4,9,11 In the literature, two
case reports have described esophageal perforations second-
ary to explosion injuries, yet our patient’s injury was the first
to describe a high-pressure explosion with a diesel cap. 12,13 In
contrast, Guth et al. described an explosion from a compressed
air tank causing metal to strike the patient’s face, with the pa-
tient’s course complicated by acute respiratory distress syn-
drome from sepsis secondary to mediastinal contamination,
requiring prolonged pleural and gastric drainage and enteral
nutrition. Roan et al. described an air-blast impact second-
12
ary to a nitrogen tank explosion complicated by leakage from
the primary repair requiring transhiatal esophagectomy and
reconstruction of the esophagus with ileocolon. Despite these
13
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