Fig. 5

a Intraoperative photograph; severe adhesions in the thoracic cavity were carefully and patiently detached, although there were some bleeding observed. b Intraoperative photograph; a fistula connecting the esophageal perforation to the left thoracic cavity was exposed, and purulent fluid drained (arrow). c Surgical specimen. Esophageal ulcer with perforation with a size of 28 × 20 mm (arrow). The esophageal adventitia was detached from the esophagus to the trachea in the area enclosed by the dotted line. The hole (asterisk) was unintentionally created after the specimen was resected. d, e Pathological examination revealed inflammatory cell infiltration and granuloma formation. Hematoxylin and eosin stain. d × 20, and e × 40