POST-SCLEROTHERAPY ESOPHAGEAL PERFORATIONS IN LIVER-TRANSPLANT PATIENTS

Esophageal perforations in liver transplant patients are associated wi th high morbidity and mortality (1). We describe 2 cases of esophageal perforations following sclerotherapy for variceal bleeding. Diagnosis was made 20 and 6 days post-sclerotherapy and 16 and 4 days post-live r transplant. Both cases were treated with pharyngeal drainage or dive rsion, pleural drainage, gastrostomy, intravenous hyperalimentation, e nteral feeding, antibiotics, withdrawal of steroids and reduction of i mmunosuppressive drugs. In both cases closure of the fistula occurred within 10 to 14 days after detection and with no sip of esophageal str icture formation. We believe this approach to esophageal perforations may be used safely in liver transplantation patients if close monitori ng of potential complications is adhered to. This approach obviates th e risks of thoracotomy without compromising the basic surgical princip les of exclusion and drainage.