DELAYED PERFORATION OF THE ESOPHAGUS BY A CLOSED THORACOSTOMY TUBE

We report on a previously undocumented complication of a trocar-free t horacostomy tube-delayed perforation of a normal esophagus. The compli cation presented clinically with fever and copious enteric drainage fo ur days after thoracostomy tube insertion. Diagnosis was established b y a contrast study of the esophagus. Retrospectively, the postinsertio n chest radiograph showed the offending thoracostomy tube tip impingin g on the posterior mediastinum, displacing an indwelling nasogastric t ube. Early recognition and repositioning of the thoracostomy tube is t he key in preventing this rare but serious complication.