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Synchronous perforations of the oesophagus and stomach by air insufflation: an uncommon complication of endoscopic dilation
  1. Arthur M Fung,
  2. Fion S Chan,
  3. Ian Y Wong,
  4. Simon Law
  1. 1Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong
  1. Correspondence to Professor Simon Law, Cheung Kung-Hai Professor in Gastrointestinal Surgery, Chief, Division of Oesophageal and Upper Gastrointestinal Surgery Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong slaw{at}


A 72-year-old woman had a history of carcinoma of the hypopharynx treated by total laryngectomy, circumferential pharyngectomy and free jejunal graft. Endoscopic dilation of the pharyngojejunal anastomotic stricture resulted in synchronous perforations of the oesophagus and stomach. We postulate that the perforations were caused by high intraoesophageal and intragastric pressure resulted from air insufflation during the procedure; in a situation simulating closed-loop obstruction, because of proximal obstruction by the endoscope at the stricture site and distal obstruction by pylorospasm. The sites of perforations were inherent points of weakness at the left side of the distal oesophagus and at the high lesser curve of stomach. Satisfactory outcome of our patient was attributed to prompt diagnosis and surgical repair. Endoscopists should be aware of this possibility during oesophagogastroduodenoscopy and dilation. Rapid and over insufflation of air should be avoided.

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  • Contributors AMF involved in drafting of the article. FSC contributed to conception and critical revision of the article. IYW and SL involved in critical revision of the article. AMF, FSC, IYW and SL contributed to final approval of the version to be published.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.