Hot potato causing full-thickness esophageal burn and perforation: a case report

Background: Esophageal perforation is a heterogeneous clinical entity. The common denominator is mediastinal contamination by digestive contents possibly evolving to sepsis, multiorgan failure, and death if not timely and appropriately treated. Mortality ranges between 10% and 20% while delay in treatment (>24 hours) has been shown to be a valuable inverse survival predictor. Non-operative management (NOM) and endoscopic treatment may be considered in stable patients with early presentation, limited esophageal disruption, and contained contamination. On the contrary, surgery should be considered in patients who do not meet NOM criteria. General principles of surgical management include exposure, debridement of nonviable tissue, tension-free defect closure, suture buttressing, and drainage. Esophageal exclusion, diversion, or resection should be considered when primary repair is not feasible. Case Description: This case report details our experience managing a large punched-out perforation of the thoracic esophagus caused by ingestion and impaction of a microwave-heated new potato. Thoracic computed tomography (CT) and upper endoscopy were detrimental for diagnosis revealing 4 cm x 2 cm esophageal full-thickness parietal loss with mediastinal contamination. The patient underwent hybrid esophagectomy via laparoscopy and right thoracotomy with gastric conduit reconstruction. The circular stapled anastomosis was located at the apex of the thorax and reinforced with a pleural patch. The postoperative course was uneventful, and the patient was discharged home on postoperative day (POD) 9. Conclusions: To the best of our knowledge, this is the first reported case of full-thickness esophageal burn and perforation after the ingestion of a microwave-heated new potato. Despite this being anecdotal evidence, ingestion and impaction of microwave-heated solid food may potentially cause full-thickness esophageal perforation.