Presentation
Recurrent aspiration after oesophagectomy.
Patient Data
There has been a previous oesophagectomy and gastric pull through, forming a neo-oesophagus.
Following the administration of oral gastrografin contrast, there is contrast extravasation into the soft tissues behind the neo-oesophagus consistent with an oesophageal leak.
Additionally, there are inflammatory changes in the right basal area extending towards the posterior mediastinum behind the neo-oesophagus, consistent with secondary mediastinitis and right lower lobe collapse.
Case Discussion
Key learning points:
CT with oral contrast can reveal contrast extravasation, indicating the presence of an oesophageal defect, such as a leak or a fistulation tract 1
Gastrografin is normally avoided if there is a history of aspiration due to the risk of pulmonary oedema
Soft tissue changes are common around the oesophageal defect, reflecting secondary inflammation and infection 2
The most common cause of an oesophageal defect is iatrogenic, from endoscopic procedures such as balloon dilation 3
Patients who have undergone oesophageal surgery may develop oesophageal defects as a late complication, commonly occurring at the anastomotic site where blood supply is poor 4
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