British Journal of Anaesthesia, 2000, Vol. 84, No. 5 643-646
© 2000 The Board of Management and Trustees of the British Journal of Anaesthesia
Case Report |
Oesophageal perforation following perioperative transoesophageal echocardiography
1 Sir Humphry Davy Department of Anaesthesia, Bristol Royal Infirmary, Bristol BS2 8HW, UK
2 Bristol Heart Institute, Bristol Royal Infirmary, Bristol BS2 8HW, UK
3 Department of Cardiothoracic Surgery, Bristol Royal Infirmary, Bristol BS2 8HW, UK
4 Department of Radiology, Bristol Royal Infirmary, Bristol BS2 8HW, UK
S. R. Massey, Sir Humphry Davy Department of Anaesthesia, Bristol Royal Infirmary, Bristol BS2 8HW, UK
Transoesophageal echocardiography (TOE) is being used more often by cardiothoracic anaesthetists for the perioperative management of cardiac problems. Reports of iatrogenic oesophageal perforation by instrumentation of the oesophagus are increasing.1 Although TOE is considered safe,2 3 it may be more risky during surgery, because the probe is passed and manipulated in an anaesthetized patient. It may be in place for several hours so the risk of mucosal pressure4 and thermal damage is increased. Patients on cardiopulmonary bypass are also fully anticoagulated. We describe a case of oesophageal perforation following insertion of the TOE probe in a patient with gross cardiomegaly. Oesophageal distortion by cardiac enlargement may increase the risk of oesophageal perforation. Difficulty in passage of the TOE probe should be regarded with suspicion and withdrawal should be contemplated because the symptoms of oesophageal perforation are often delayed5 and non-specific.1 Delay in investigation, diagnosis and treatment will increase morbidity and mortality.6–8
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