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Surgery
During endoscopic biopsy of a distal esophageal cancer, perforation of the esophagus is suspected when the patient complains of significant new substernal pain. An immediate chest film reveals air in the mediastinum. You would recommend
Placement of a nasogastric tube to the levels of perforations, antibiotics, and close observation
Spit fistula (cervical pharyngostomy) and gastrostomy
Left thoracotomy, pleural patch oversewing of the perforation, and drainage of the mediastinum.
Esophagogastrectomy celiotomy and right thoracotomy
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