Questions

A 54 yo alcoholic man presents to the emergency department with severe substernal and epigastric pain after vomiting while drinking alcohol earlier in the evening. Gastrografin esophagogram shows perforation of distal esophagus with drainage into the mediastinum. What is the most appropriate treatment?

• Nonoperative management with total parenteral nutrition (TPN) and nasogastric decompression

• Emergent primary repair

• Esophagectomy and delayed reconstruction with interposition graft

• Esophagostomy and placement of a feeding jejunostomy tube