Esophageal rupture after regional anesthesia - Report of two cases

Esophageal perforation after anesthesia is rare. It is usually secondary to esophageal instrumentation. Only one case of barogenic rupture after regio nal anesthesia has been reported. We report two additional cases and presen t possible mechanisms for this unusual entity. Neither patient had anatomic abnormalities by history or preoperative endoscopy. However, both patients and the previously reported patient had esophageal dysmotility resulting f rom advanced age, alcoholism, intraoperative medications, and preexisting d isease. Each patient experienced at least one episode of emesis with subseq uent perforation of the distal one third of the esophagus. The previously r eported patient died; both of our patients underwent successful surgical re pair and are alive 2 years later. Intraoperative or postoperative emesis in patients with esophageal dysmotility appears to be the principal factor ca using esophageal rupture after regional anesthesia. Prevention of nausea an d vomiting and recognition of this high-risk population may minimize this c omplication in the future.