Successful nonoperative management of delayed spontaneous esophageal perforation in patients with human immunodeficiency virus

Objective: To describe the clinical outcome of esophageal stenting for repair of distal esophageal perforation in one patient with septic shock and human immunodeficiency virus. Design: Case report. Setting: Medical-surgical intensive care units of one university teaching hospital. Patient One patient with human immunodeficiency virus infection and septic shock in whom there was a delay in diagnosis of spontaneous perforation at the distal thoracic esophagus. Intervention: A 10 cm x 2 cm silicone lined, partially coated, expandable metal stent was fluoroscopically placed in the distal esophagus at the perforation. Other treatment included chest tube thoracostomy, sump drainage of proximal esophagus, percutaneous gastrostomy, and antibiotics. Measurement and Main Results: Septic shock and the distal esophageal perforation were successfully treated with combined esophageal stenting, thoracostomy pleural drainage and antibiotics. Esophageal stenting was accomplished fluoroscopically with a partially coated, silicone-lined, expandable metal stent. Conclusion: Esophageal stenting, tube thoracostomy drainage, and antibiotics may be a management option for gravely ill patients with human immunodeficiency virus, esophageal perforation, and a delay in diagnosis. An optimal outcome requires a thoughtful, individualized approach and adherence to basic principles.