T-tube insertion as a salvage procedure for failed primary repair in penetrating esophageal injury complicated by sepsis: a case report from low resource setting

Abstract

Introduction and importance: Esophageal perforation is a life-threatening emergency associated with high morbidity and mortality. Case presentation: A 28-year-old female presented with a cervical esophageal stab injury. An initial primary repair failed, and the patient developed severe sepsis. Surgical re-exploration revealed two esophageal perforations. The lateral perforation was repaired, and a T-tube was inserted through the anterior defect to create a controlled fistula. A feeding jejunostomy was also performed. The patient recovered fully following 9 weeks of T-tube drainage and enteral feeding. Clinical discussion: Cervical esophageal perforations present unique management challenges due to their proximity to vital structures and the high risk of mediastinal sepsis. Primary repair is preferred when feasible; however, failure can result in uncontrolled leakage and infection. In such cases, T-tube drainage provides a controlled fistula that allows decompression, sepsis control, and spontaneous closure once healing occurs. Compared to advanced techniques such as endoscopic stenting or vacuum-assisted closure, T-tube diversion is simple, inexpensive, and suitable for resource-limited environments. Adequate drainage, nutritional support through feeding jejunostomy, and close follow-up are critical to achieving favourable outcomes. Conclusion: T-tube drainage is a valuable salvage option in the management of complicated oesophageal perforations in resource-limited settings and nutritional support through feeding jejunostomy are key to optimizing outcomes.