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Perioperative Airway Management and Septic Shock Resuscitation in Patients with Esophageal Rupture Complicated by Pyothorax Undergoing Thoracotomy: A Case Report
Author(s): Haijing Ren1*
1Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
Corresponding Author: Haijing Ren
Address: Department of Anesthesiology, West China Hospital, Sichuan University, No. 37, Guoxue Valley, Wuhou District, Chengdu 610041, Sichuan Province, China.
Received date: 22 May 2026; Accepted date: 06 June 2026; Published date: 13 June 2026
Citation: Ren H. Perioperative Airway Management and Septic Shock Resuscitation in Patients with Esophageal Rupture Complicated by Pyothorax Undergoing Thoracotomy: A Case Report. Asp Biomed Clin Case Rep. 2026 Jun 13;9(2):112-16.
Copyright © 2026 Ren H. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.
Keywords: Esophageal Rupture, Pyothorax, Septic Shock, One-Lung Ventilation, Rapid Sequence Induction, Norepinephrine, Airway Management
Abbreviations: OLV: One-Lung Ventilation; PEEP: Positive End-Expiratory Pressure; RSI: Rapid Sequence Induction
Abstract
Introduction: Esophageal rupture with pyothorax and septic shock is a life-threatening emergency. Patients undergoing emergency thoracotomy face the dual challenges of airway management and hemodynamic support during one-lung ventilation (OLV).
Case Presentation: A 71-year-old man presented with esophageal rupture, right-sided pyothorax, and fistulas. Rapid sequence induction (RSI) was chosen to avoid positive-pressure ventilation. During OLV, hypoxemia was managed with positive end-expiratory pressure (PEEP) and intermittent two-lung ventilation. Hypotension required norepinephrine; however, intraoperative lactate levels remained within the normal range. The patient recovered without major complications.
Conclusion: Successful perioperative management hinges on RSI to avoid positive-pressure ventilation, a stepwise approach to OLV-induced hypoxemia, and early vasopressor support, with recognition that hypotension is primarily driven by septic shock. Normal lactate levels can serve as a reassuring marker of adequate resuscitation.