Giriþ: Eozinofilik özofajit (EoE), kronik inflamatuvar bir hastalýk olup disfaji ve gýda impaksiyonu ile karakterizedir. Nadir de olsa spontan özofagus perforasyonu geliþebilmektedir. Bu perforasyonlar çoðunlukla distal özofagus ve gastroözofageal bileþkede ortaya çýkmakta, genellikle cerrahi veya endoskopik yöntemlerle tedavi edilmektedir. Erken taný ve perforasyon sonrasý ilk 24 saat içerisinde tedaviye baþlanmasý mortalite ve morbiditeyi belirgin þekilde azaltmaktadýr. Bu yazýnýn amacý, eozinofilik özofajite baðlý geliþen gastroözofageal bileþke perforasyonunun, özellikle gecikmiþ olgularda da konservatif yöntemle baþarýlý þekilde yönetilebileceðini vurgulamak ve bu nadir fakat potansiyel olarak hayatý tehdit eden komplikasyonun tedavi stratejilerine katký saðlamaktýr.
Olgu Sunumu: Otuz beþ yaþýnda, bilinen EoE tanýsý ve 12 yýllýk disfaji öyküsü bulunan erkek hasta, retrosternal aðrý, nefes darlýðý ve hematemez þikâyetleri ile acil servise baþvurdu. Öyküsünden yaklaþýk beþ gün önce ýzgara tavuk tüketimi sonrasý boðaz aðrýsý ve viþne renginde ishal geliþtiði, semptomlarýný hafifletmek amacýyla ibuprofen kullandýðý öðrenildi. Kontrastlý görüntüleme ve endoskopide gastroözofageal bileþkede perforasyon saptandý. Lezyonun lokalizasyonu nedeniyle stentleme endoskopik klipsleme uygun bulunmadý. Akut batýn, koleksiyon veya mediastinit bulgularý olmamasý üzerine konservatif tedavi planlandý. Hasta yoðun bakým ünitesinde izleme alýndý. Baþlangýçta seftriakson (2 g/gün) ve metronidazol (1,5 g/gün) ile baþlanan antibiyotik tedavisi, enfeksiyon hastalýklarý konsültasyonu sonrasý piperasilin–tazobaktam (4,5 g, 6 saatte bir) ile deðiþtirildi. Klinik seyri stabil olan hastada oral alým 6. günde baþlatýldý. Onuncu günde antibiyotik tedavisi sonlandýrýlarak hasta komplikasyonsuz taburcu edildi. Üçüncü ay takip muayenesinde hasta, tekrarlayan ve progresif olarak kötüleþen disfaji yakýnmasý tarifledi. Önceden deðerlendirildiði merkezde yapýlan kontrol endoskopisinde, gastroskobun geçiþine izin vermeyen distal özofagusta striktür saptanmasý üzerine 12 cm uzunluðunda, tamamen kaplý, kendi kendine geniþleyebilen bir özofagus stenti yerleþtirildi. Stent 20 gün sonra çýkarýldý ve hastanýn sonraki altý aylýk izleminde semptom tekrarý gözlenmedi.
Sonuç: EoE baðlý spontan özofagus perforasyonu nadir ancak potansiyel olarak yaþamý tehdit eden bir komplikasyondur. Bu olgu, konservatif tedavinin sadece erken taný konulan deðil, ayný zamanda gecikmiþ olgularda da multidisipliner yaklaþýmla dikkatle seçilmiþ hastalarda cerrahi veya endoskopik giriþimlere etkili bir alternatif olabileceðini göstermektedir. Striktür geliþimi gibi geç komplikasyonlarýn erken saptanabilmesi için uzun dönem takip kritik öneme sahiptir.

Anahtar Kelimeler: Eozinofilik özofajit, özofagus perforasyonu, konservatif tedavi, striktür

Conservative Management of Gastroesophageal Junction Perforation Secondary To Eosinophilic Esophagitis: A Case Report

Background: Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus characterized by dysphagia and food impaction. Although rare, spontaneous esophageal perforation can occur, most commonly involving the distal esophagus and gastroesophageal junction. These perforations are generally managed by surgical or endoscopic interventions. Early diagnosis and prompt initiation of therapy within the first 24 hours after perforation markedly reduce morbidity and mortality. The aim of this report is to highlight that gastroesophageal junction perforation secondary to eosinophilic esophagitis can be successfully managed conservatively even in delayed presentations, and to contribute to the understanding of treatment strategies for this rare but potentially life-threatening complication.
Case Presentation: We report a 35-year-old male with a known 12-year history of EoE who presented to the emergency department with retrosternal pain, dyspnea, and hematemesis. Five days prior, he had developed sore throat and cherry-colored diarrhea after consuming grilled chicken and had self-administered ibuprofen for symptom relief. Contrast-enhanced imaging and upper endoscopy revealed a perforation at the gastroesophageal junction. Due to the location of the lesion, endoscopic stenting or clipping was deemed inappropriate. In the absence of acute abdomen, mediastinitis, or significant fluid collection, a conservative management strategy was adopted. The patient was admitted to the intensive care unit and initially received intravenous ceftriaxone (2 g/day) and metronidazole (1.5 g/day), which were later switched to piperacillin–tazobactam (4.5 g every 6 hours) following infectious disease consultation. His clinical course remained stable, and oral intake was initiated on day 6. On the tenth day, antibiotic therapy was discontinued, and the patient was discharged without complications. At the third-month follow-up, the patient reported recurrent and progressively worsening dysphagia. Control endoscopy at the previously visited center revealed a distal esophageal stricture that prevented passage of the gastroscope; therefore, a 12-cm fully covered self-expandable esophageal stent was placed. The stent was removed 20 days later, and the patient remained asymptomatic during the subsequent six-month follow-up period.
Conclusion: Spontaneous esophageal perforation secondary to EoE is rare but potentially life-threatening complication. This case highlights that conservative management can be a viable alternative to surgical or endoscopic intervention not only in early detected but also in delayed presentations when carefully selected and managed in a multidisciplinary setting. Long-term follow-up remains essential to promptly detect and treat late complications such as stricture formation.

Keywords: Eosinophilic esophagitis, esophageal perforation, conservative management, stricture