Multidisciplinary Management of Esophageal Perforation and Septic Shock Following Peroral Endoscopic Myotomy in an Elderly Patient: A Case Report.

Esophageal stents are indicated for strictures, leaks, and perforations, but contraindications include uncontained perforations, uncontrolled sepsis, and necrotic tissue. We report a case of a 73-year-old female with an esophageal perforation after peroral endoscopic myotomy who underwent chest tube placement, video-assisted thoracoscopic surgery with attempted repair, and placement of two overlapping esophageal stents extending into the stomach. Despite stenting, she further decompensated and developed esophageal necrosis requiring esophagectomy, removal of necrotic tissue, creation of a spit fistula, and retrieval of both stents. Although within the allowable length, the stents were placed in necrotic tissue and extended into the stomach, resulting in further complications that could have been avoided with early surgical intervention. This case underscores that stenting, especially in excessive length, in necrotic tissue, can worsen necrosis and complicate surgery. In such cases, early esophagectomy may be the more definitive option in these scenarios.