This case involves a patient who underwent hiatal hernia repair via da Vinci surgical robot surgical technology. The procedure was complicated by esophageal perforation. Postoperatively, the perforation was not discovered for some time, which resulted in a two-month hospital stay with long-term dysfunction. Upon discovering the perforation, the patient had to be transferred to a different facility. She now suffers from dysphagia permanently.
Question(s) For Expert Witness
- 1. What is the common presentation of an esophageal perforation?
Expert Witness Response
Patients with esophageal perforation present classically with excruciating retrosternal chest and upper abdominal pain. Odynophagia, tachypnea, dyspnea, cyanosis, fever, and shock develop rapidly thereafter. Physical examination is usually not helpful, particularly early in the course. Subcutaneous emphysema (crepitation) is an important diagnostic finding but is not very sensitive. These patients are to be followed very closely postoperatively with daily chest x-rays. If abnormal CXR is seen, one can follow up with a CT scan, esophagram, and upper endoscopy.