Vol. 61, No. 4, April 2011 418 Students’ Corner Case Report T-tube management of late esophageal perforation Irfan Qadir, 1 Hasnain Zafar, 2 Mubashir Zareen Khan, 3 Hasanat Mohammad Sharif 4 Medical Student, 1 General Surgery Section, 2 CardioThoracic Surgery Section, 3,4 Aga Khan University Hospital, Karachi. Abstract Esophageal perforation is a serious condition with a high mortality rate. Management strategy of such a patient depends on the extent of perforation and the time interval between perforation and diagnosis. The use of a T tube to treat delayed esophageal perforation with complete resolution and no need for future definitive surgery has been less frequently described. We adapted this principle in successful management of a 73 year old patient with four days history of fever, shortness of breath, chest pain and radiological evidence of perforation. Keywords: Esophageal perforation, T-tube, Pleuromedinitis. Introduction Esophageal perforation is the most serious injury of the digestive tract due to free drainage of gastric contents into the mediastinum leading to development of severe pleuromediastinitis, chest empyema, sepsis and multiple organ dysfunction syndrome. The mortality rate ranges between 20% and 30%. 1 Iatrogenic injury is the most common cause of esophageal perforation. Other causes include spontaneous perforation (Boerhaave syndrome), caustic chemical ingestion, foreign body penetration and trauma. 2 The diagnosis depends on a high degree of suspicion, recognition of clinical features and confirmation by contrast esophagography or endoscopy. 3 Treatment may be conservative or surgical, depending on the cause, site, extent of perforation and time lapsed since perforation, and the overall health of the patient. 4 Case Report A 73 year old male was admitted in the Emergency department following referral from a local general practitioner where he initially presented 4 days previously with fever, shortness of breath, cough and gradually worsening chest pain following acute bouts of vomiting. He was managed with antibiotics for pneumonia but due to worsening symptoms he was refered to this tertiary care hospital. On examination, the patient was in respiratory distress. His vitals were: Pulse 120/min, Blood Pressure 100/60mmHg, Temperature 38ºC, Respiratory Rate 28/min and oxygen saturation of 93.8%. His chest was dull on