1). There was no evidence of pneumothorax or soft tissue emphysema. After discussing with the surgeons, upper endoscopy under general anesthesia was performed, with patient consent, in the presence of a surgical team. An across located sharp-edged chicken bone (4 cm long) was identified in the mid-esophagus, with bilateral MAPK inhibitor perforation of submucosa and muscular layers with the surrounding area being ulcerated bilaterally. The chicken bone was gently removed with a mouse tooth forceps (Fig. 2) after identification of the shallower end, with immediately drainage of

the abscess onto the esophageal lumen. A 2 cm long midesophageal perforation was visualized. Given the lack of pulmonary symptoms and no evidence of mediastinitis, the team decided on nonsurgical management. To allow further drainage, without blocking with a stent, a nasogastric tube was placed under direct visualization.

The patient was started on broad-spectrum antibiotherapy, proton pump inhibitors and total parenteral nutrition. The control esophagogram (Fig. 3) and computed tomography scan, performed in the day after, revealed a small-contained leak, with no evidence of mediastinic extravasation and no regional signs of infection. The patient was kept on total parenteral nutrition for 8 days, started enteral nutrition on the eighth day and progressed to oral feeding on the twelfth day. The two-week control esophagogram this website revealed no signs of leakage. Patient improved steadily, with normalization of blood chemistry Dynein parameters of infection (C-reactive protein 3 mg/L at discharge), with no in-hospital complications and no complaints of difficulty in swallowing. He was discharged on proton pump inhibitors. Although the primary treatment for esophageal perforation is surgical, endoscopic therapies may play a role and be appropriate in individualized cases. Treatment depends on the etiology, site, and size of perforation, the time elapsed between perforation and diagnosis, underlying

esophageal disease and the overall health status of the patient. Criteria for non-surgical treatment include perforation that is confined to the mediastinum, drainage of the cavity back into the esophagus, clinical stability, and minimal clinical signs of sepsis.10 and 11 Perforation of the cervical esophagus can be managed conservatively in most cases, as well as, perforations of the intrathoracic esophagus that are confined to the mediastinum12; however, perforations of the lower two thirds of the esophagus that affect the pleura, pericardium, or peritoneum require rapid surgical intervention. Choosing an endoscopic therapy for an esophageal perforation requires differentiating between acute and chronic cases.