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Question 2 · LEK · Gastrointestinal perforation

The patient in poor general condition was transported to the hospital admission room. He reports a retrosternal pain and high fever. On the physical examination the crackling of the skin was palpable around the neck. The patient had been diagnosed with advanced oesophageal cancer. The chest CT showed the presence of air in the mediastinum, contrast leakage in the thoracic section of the esophagus and fluid effusion in the right pleural cavity. Indicate the optimal surgical procedures in this case:

  1. A. a gastric probe, a ban on oral nutrition, antibiotic therapy.
  2. B. stitching the oesophagus with an access via right-sided thoracotomy.
  3. C. exclusion of the oesophagus through the emergence of oesophagostomy on the neck, mediastinal drainage, occlusion of the gastric gullet, further nutrition by nutritional gastrostomy.
  4. D. oesophageal resection with gastroesophageal anastomosis in the cage chest.
  5. E. implantation of a self-expanding stent with optional drainage of the right pleural cavity. 1 z 117 29.06.2026, 14:15 Centrum Egzaminów Medycznych https://test.cem.edu.pl/pytcem/wyswietl_baza_pdf.php
Hint

Weigh the patient's prognosis and septic state against the invasiveness of each option; a perforation through an unresectable tumour needs a palliative seal.

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