Outside the scope of our practice: an unexpected thoracoscopy and pleurocentesis during gastroscopy.

an unexpected thoracoscopy and pleurocentesis during gastroscopy A 56-year-old man described 2 weeks of regurgitation of ingested liquids, dyspnea, and chest pain. He had undergone laparoscopic esophagectomy with cervical anastomosis 1 year previously for esophageal adenocarcinoma; this had been complicated by a stricture at the esophagogastric anastomosis that required serial endoscopic dilations. Shortly after admission, a computed tomography (CT) scan demonstrated a dilated, fluid-filled intrathoracic stomach. Therewasobstruction to thepassage of oral contrast at the level of the intrathoracic duodenum, and a left-sided pleural effusionwas seen (●" Fig.1). At gastroscopy, 1L of fluid was aspirated from the intrathoracic stomach. There was an angulated deformity of the intrathoracic junction of the first and second part of the duodenum in association with a perforated ulcer on the posterior duodenal wall (●" Fig.2a). The gastroscope was inserted through this perforation and into the left pleural space, from which 2L of turbid fluid were aspirated (●" Fig.2b). Fibrinopurulent exudate (●" Fig.2c) was seen on the surfaces of the lung and dia-