{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T06:02:04Z","timestamp":1780639324651,"version":"3.54.1"},"reference-count":9,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>After repair of Boerhaave syndrome, assessment of repair integrity is important because occult dehiscence may progress to mediastinitis or pleural sepsis. Water-soluble contrast esophagography is widely used before resuming oral intake, but absence of extravasation does not necessarily exclude a small or contained defect. We report a 59-year-old man with post-emetic distal esophageal rupture treated by emergency primary repair with pleural-flap buttress and drainage. Although clinically stable, contrast esophagography on postoperative day (POD) 7 showed no extravasation. Because feeding decisions required greater structural confidence, low-insufflation carbon dioxide esophagogastroduodenoscopy was performed on POD 9 and revealed focal suture-line dehiscence. Oral intake was deferred and conservative management continued. A regular diet was started only after POD 28 endoscopy showed marked interval healing; 3-month follow-up confirmed complete mucosal healing. Contrast esophagography remains the standard postoperative assessment; nevertheless, this hypothesis-generating case suggests that, in carefully selected, clinically stable patients with high-risk anatomic features, low-insufflation carbon dioxide endoscopy may provide complementary structural information when feeding decisions remain uncertain after a negative contrast study.<\/jats:p>","DOI":"10.3390\/diagnostics16111670","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T10:06:56Z","timestamp":1780049216000},"page":"1670","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Negative Contrast Esophagography Does Not Exclude Dehiscence After Boerhaave Repair: Complementary Low-Insufflation Carbon Dioxide Endoscopy"],"prefix":"10.3390","volume":"16","author":[{"given":"Hee Suk","family":"Jung","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si 13496, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0982-7851","authenticated-orcid":false,"given":"Gong Min","family":"Rim","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si 13496, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Mog","family":"Shim","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si 13496, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwan Wook","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si 13496, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s13017-019-0245-2","article-title":"Esophageal emergencies: WSES guidelines","volume":"14","author":"Chirica","year":"2019","journal-title":"World J. Emerg. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2228","DOI":"10.1007\/s00464-025-11540-8","article-title":"Treatment of Boerhaave syndrome: Experience from a tertiary center","volume":"39","author":"Kooij","year":"2025","journal-title":"Surg. Endosc."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Eremia, I.-A., Anghel, C.-A., Cofaru, F.-A., and Nica, S. (2024). Early presentation of Boerhaave syndrome in the emergency department: A case report and review of the literature. Diagnostics, 14.","DOI":"10.3390\/diagnostics14151592"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/j.athoracsur.2022.04.053","article-title":"Half of anastomotic leaks after esophagectomy are undetected on initial postoperative esophagram","volume":"115","author":"Elliott","year":"2023","journal-title":"Ann. Thorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1007\/s00464-007-9629-6","article-title":"Prospective trial comparing contrast swallow, computed tomography and endoscopy to identify anastomotic leak following oesophagogastric surgery","volume":"22","author":"Hogan","year":"2008","journal-title":"Surg. Endosc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"631","DOI":"10.2214\/AJR.19.22166","article-title":"Diagnostic utility of CT and fluoroscopic esophagography for suspected esophageal perforation in the emergency department","volume":"215","author":"Wei","year":"2020","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2252","DOI":"10.1016\/j.cgh.2021.06.045","article-title":"AGA Clinical Practice Update on endoscopic management of perforations in gastrointestinal tract: Expert review","volume":"19","author":"Lee","year":"2021","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1016\/j.surg.2024.01.004","article-title":"Early postoperative endoscopy for predicting anastomotic leakage after minimally invasive esophagectomy: A large-volume retrospective study","volume":"175","author":"Ma","year":"2024","journal-title":"Surgery"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Shen, Y., Ren, X.-F., Xu, H., Gao, F., Sun, J.-W., and Bai, Y.-Q. (2026). Ultra-early postoperative endoscopy reduces anastomotic leak after minimally invasive esophagectomy: A propensity score-matched study. Surg. Endosc., online ahead of print.","DOI":"10.1007\/s00464-026-12855-w"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/11\/1670\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:15:51Z","timestamp":1780636551000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/11\/1670"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,28]]},"references-count":9,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["diagnostics16111670"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16111670","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,28]]}}}