[Bleeding from the esophagus in a patient after laryngectomy]

The report present a study of a case of a 38 year old man, suffering from massive haemorrhage from esophagus on the 21st day after performed laryngectomy. Serious difficulties occurred at first in specifying the exact sources of haemorrhage (cervical vessel, gastric ulcer?). The surgical assessment of the neck vessels and laparotomy were performed without finding any sources of bleeding. The haemorrhage was eventually stopped by the application of Sengstaken's tubene, but it reoccurred when a trial to remove was undertaken. Thoracotomy to assess the mediastinal vessels did not reveal the sources of bleeding. 22 units of blood were administered in transfusion. This patient died 10 days after the beginning of the haemorrhage. In autopsy the diffuse inflammatory process of the oesophageal wall, multiple corrosive points in the mucous and deep, large ulceration (2.5 x 1 cm in diameter) within posterior oesophageal wall located in the middle stenosis were found. Discussing the possible causes of the bleeding the authors point out to the fact that the presence of the naso-oesophageal catheter could have been one of them. The authors also express the opinion, that persisting hiccups can be regarded ad a characteristic symptom of developing oesophagitis which actually was observed in the presented case.