Esophageal leak management using nasocavity drain on banded fenestrated strand. We have no disclosures. Leakage of esophageal content through esophageal perforation can cause epsis around the esophages of user space. These epsises are difficult to manage, particularly if the leak is in proximal esophages. The dependent part of the epsis then ends up draining into respiratory tract or puerile space leading to complicated fistulas. Also, leaks in proximal esophages are difficult to manage with the strand as there is limited landing space for the strand. We present a case of 40-year-old male who presented with difficulty swallowing. On his radiological and endoscopic imaging, his entire esophages were narrowed down to 5 mm and there was extensive compression. On further investigation, we noted the parasitogen leak for the large hematoma compressing the esophagus. We can see the leak on the CT scan. Endoscopic method. We inadvertently used a suction tubing to create a cap for a pediatric upper endoscope to investigate the leak. After identifying the leak, a nasocaptive drain was placed which was a MCL 12-inch 60 cm. This was left to rest for 10 days. At that point, we rewound the patient back as shown in the photo that either the hematoma or the presence of drain in this space resulted in more than one opening of the fistula to spontaneously drain the hematoma. However, the distal part of it was still dependent enough to accumulate a big infectious process. The option at this time was either to do a septotomy or to put a wire as an in and out wire and over that wire put a soft cellistic stand as shown here. The stand was placed, we thought about using a suture to keep drain in place. However, it was felt that because of the mucosal health, such approach will not be feasible and also due to limitation of human space, we elected to use bands at the end of the two free ends of the double-pictal drain to provide a constant drainage of the paraesophageal space. Without the need of septotomy, as shown in the image, the double-pictal drain has one part of it in the esophageal human and the second in the paraesophageal space and close to the distal end, the two pictal are held in place with the bands. We can see the fistulas over here. We put the guide wire from esophagus into the paraesophagus backwards i.e. from distal to the proximal as shown here. The urethral strand was passed over the guide wire and the proximal part of this strand was banded as we couldn't suture it due to the ill mucosal health. At 7 weeks follow-up, patient was asymptomatic and paraesophageal cavity has dissolved to the level that there was no abscess cavity and it was a leading track along the drain. The bands were cut and the drains were removed.

Esophageal leaks

severe infections

fistulas

narrowed esophagus

nasocaptive drain