Instrumental perforation of the oesophagus into the pericardial cavity.

A 66 year old man with no previous oesophageal symptoms developed acute dysphagia and vomiting shortly after a large meal. About 16 hours later a large piece of meat was removed from the oesophagus at the 30 cm level under general anaesthesia through a rigid oesophagoscope. The surgeon who performed the endoscopy explored the distal oesophagus for strictures and noticed that the oesophagoscope would not pass beyond 40cm. A few hours later the patient developed moderately intense chest pain and surgical emphysema of the lower neck. He was given penicillin and gentamicin intravenously and transferred to the Regional Cardiothoracic Centre for further management. The patient had a heart rate of 105 beats/min and a