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Gastric conduit perforation induced by massive beer drinking

A 55-year-old man with a 4-year gastric conduit after esophagectomy presented to the Emergency Department with severe right chest pain and short of breaths following massive beer drinking. Chest film and computed tomography revealed right pneumo-hydrothorax. A total of 150 mL fresh blood was initially drained out via tube thoracostomy. On the third day, the drainage amount of right pleural fluid dramatically increased and its color changed to deep gray. Diagnosis of gastric conduit perforation was established. He underwent thoracoscopic decortication, repair of the retrosternal gastric conduit, and feeding jejunostomy on post-perforation day 4. Secondary repair of the perforation was performed via anterior thoracotomy because of re-leaks on post-perforation day 11. He underwent tracheostomy and esophageal stent on post-perforation day 33 because the perforation hole was still not healed. In the hospital course, he required 32-day ventilatory support because of respiratory failure resulted from bilateral pneumonia. He gradually recovered and was discharged on post-perforation day 63.