[Esophageal perforation in a fruitless attempt at endotracheal intubation]

Esophageal perforation is a rare but potentially serious complication of endotracheal intubation, often leading to mediastinitis. The diagnosis should be performed rapidly, based on suggestive clinical signs as well as on plain chest roentgenograms and contrast esophagogram. The usual treatment consists of broad spectrum antibiotherapy, prompt surgical closure of the perforation and adequate drainage of the area. The overall mortality rate of about 50% is significantly reduced if therapy is begun within the first 12 hours. A number of ancillary tests and clinical criteria have been proposed in order to assess difficult intubations. The authors report a case of esophageal perforation following a difficult intubation, resulting in acute respiratory distress, subcutaneous emphysema and bilateral pneumothorax. An early diagnosis and prompt surgical treatment facilitated a successful outcome.