101
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Paul I, Badmanaban B, Graham ANJ. Perforation of the lower thoracic oesophagus following crush injury to the chest and abdomen. Eur J Cardiothorac Surg 2005; 27:526-8. [PMID: 15740972 DOI: 10.1016/j.ejcts.2004.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2004] [Revised: 12/01/2004] [Accepted: 12/06/2004] [Indexed: 11/24/2022] Open
Abstract
We report a case of perforation of the lower thoracic oesophagus following a crush injury to the chest and upper abdomen. A laparotomy was performed for abdominal injuries, and appropriately placed drains resulted in complete resolution of the oesophageal leak, 21 days following the injury. This case report demonstrates that a conservative approach to lower thoracic oesophageal perforations can be carried out successfully without the added morbidity of a thoracotomy, or risks of a direct repair.
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Affiliation(s)
- I Paul
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, UK.
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102
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Demirbag S, Tiryaki T, Atabek C, Surer I, Ozturk H, Cetinkursun S. Conservative approach to the mediastinitis in childhood secondary to esophageal perforation. Clin Pediatr (Phila) 2005; 44:131-4. [PMID: 15735830 DOI: 10.1177/000992280504400204] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to evaluate the safety and efficacy of nonoperative treatment of esophageal perforation (EP) in children. Between 1999 and 2004, 13 episodes in 12 patients were evaluated. The treatment program consisted of broad-spectrum antibiotics, nasopharyngeal aspiration, parenteral and/or enteral nutrition by gastrostomy, and pleural effusion or mediastinal abscess drainage when required. Mean age of the patients was 3.75 +/- 1.13 (range 3-7 years). Two patients (16.7%) were girls and 10 patients (83.3%) were boys. Chest pain was found 76.9% of all EP episodes (10 of 13 perforations), followed by dyspnea in 69.2% (9 of 13), vomiting in 46.1% (6 of 13), fever in 46.1% (6 of 13), and epigastric pain in 7.6% (1 of 13). No deaths occurred. In children, in contrast with the adults, EP can be treated safely by nonoperative methods.
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Affiliation(s)
- Suzi Demirbag
- Department of Pediatric Surgery, Gulhane Military Medical Academy, Ankara, Turkey
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103
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Abstract
Optimal management of esophageal perforation is controversial, especially in the presence of malignancy. Esophagectomy has traditionally been employed for patients with malignant perforations. However, in patients with advanced disease, other less invasive treatment options may be of benefit. We present two cases of spontaneous perforation of advanced esophageal cancer successfully managed by insertion of covered self-expanding metallic stents and a review of the literature.
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Affiliation(s)
- L Ferri
- Division of Esophageal Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
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104
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Abstract
INTRODUCTION With the rising incidence of oesophageal cancer, palliative treatment has an increasingly important role. With median survival unlikely to exceed 6 months, in advanced disease the palliative therapy chosen must not hasten patient's demise. AIM To establish the outcome of both modern and historical palliative treatment in oesophageal tumours, with emphasis on the aetiology and outcome of iatrogenic perforation. METHODS Patients with oesophageal or cardia carcinoma treated within the West Midlands between 1992 and 1996 were identified retrospectively. Information was gathered from hospital case notes and the regional cancer intelligence unit with hospitals visited to capture data. All episodes were entered into a dedicated database. RESULTS Of the 3660 patients who were treated, 2529 received palliation as primary treatment, with 5259 palliative procedures performed; 164 iatrogenic perforations were recorded; 83 were due to diagnostic endoscopy (endoscopic perforation) with the reminder due to interventional palliative procedures. Median survival from all forms of palliation was 138 days. Following perforation survival was 95 days after interventional palliative procedure and 58 days after endoscopic perforation (P > 0.05). Thirty-day mortality after emergency surgery was 11.8% with mean survival of 7.5 months. CONCLUSION Perforation at diagnostic endoscopy is associated with substantial mortality despite rapid intervention. Patients with suspected cancer must be investigated with extreme care to reduce iatrogenic complications.
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Affiliation(s)
- P Jethwa
- Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK.
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105
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Gelbmann CM, Ratiu NL, Rath HC, Rogler G, Lock G, Schölmerich J, Kullmann F. Use of self-expandable plastic stents for the treatment of esophageal perforations and symptomatic anastomotic leaks. Endoscopy 2004; 36:695-9. [PMID: 15280974 DOI: 10.1055/s-2004-825656] [Citation(s) in RCA: 158] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Extensive anastomotic leaks after esophageal resection and esophageal perforations are a therapeutic challenge. The aim of the present study was to assess the potential of the self-expandable Polyflex plastic stent for the treatment of these conditions. PATIENTS AND METHODS Between January 2002 and March 2003, nine patients were treated with a self-expandable Polyflex plastic stent for sealing of thoracic esophagoenteric anastomotic leaks following surgical resection (n = 5) or esophageal perforation (n = 4). RESULTS In all patients the stents were inserted successfully without technical problems. In all but two patients complete sealing of the leak was achieved as demonstrated by radiography with water-soluble contrast media. The stent migration rate was 30 % and repositioning of the migrated stents was possible in all cases. Complete mucosal healing of the esophageal leaks and stent extraction was achieved in six patients. The stents were in situ for an average period of 135 +/- 78 days. Two critically ill patients with anastomotic leaks died in spite of stent insertion due to sepsis and one patient with esophageal perforation died due to the underlying malignant disease. CONCLUSIONS Our preliminary experience with the self-expanding and removable Polyflex plastic stent for the sealing of anastomotic leaks and esophageal perforations suggests that this stent is a feasible treatment option, in particular, for more extensive esophageal defects, patients with co-morbid conditions, and critically ill patients.
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Affiliation(s)
- C M Gelbmann
- Department of Internal Medicine I, University of Regensburg, Germany.
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106
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Affiliation(s)
- J M Blocksom
- Department of General Surgery, Wayne State University, 4201 St. Antoine, Detroit, Michigan 48201, USA
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107
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Abstract
A 90-year-old woman sustained a proximal esophageal perforation following transesophageal echocardiography. The perforation originated at the site of a Zenker's diverticulum and resulted in a false passage to the diaphragm. Initial management involved endoscopic placement of drains into the mediastinum in addition to bilateral chest drains and a gastrostomy. Following stabilization, the patient had repair of her Zenker's diverticulum and recovered uneventfully. We recommend that all procedures involving blind intubation of the esophagus should be preceded with specific pursuit of a background of cervical dysphagia.
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108
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Chen M, Yang PP. [Cervical esophageal perforation--report of 6 cases]. Zhonghua Yi Xue Za Zhi 2004; 84:1193-5. [PMID: 15630762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Ming Chen
- Department of Ear-Nose-Laryngo-pharynx, 2nd Affiliated Hosptital, Medical college, Zhijiang University, Hangzhou 310009, China
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109
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Abstract
Esophageal perforation remains a devastating event that is difficult to diagnose and manage. The majority of injuries are iatrogenic and the increasing use of endoscopic procedures can be expected to lead to an even higher incidence of esophageal perforation in coming years. Accurate diagnosis and effective treatment depend on early recognition of clinical features and accurate interpretation of diagnostic imaging. Outcome is determined by the cause and location of the injury, the presence of concomitant esophageal disease, and the interval between perforation and initiation of therapy. The overall mortality associated with esophageal perforation can approach 20%, and delay in treatment of more than 24 hours after perforation can result in a doubling of mortality. Surgical primary repair, with or without reinforcement, is the most successful treatment option in the management of esophageal perforation and reduces mortality by 50% to 70% compared with other interventional therapies.
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Affiliation(s)
- Clayton J Brinster
- Department of Surgery, Division of Cardiothoracic Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
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110
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Abstract
BACKGROUND Treatment of esophageal perforation remains controversial and recommendations vary from initially non-operative to aggressive surgical management. Several factors are responsible for this life-threatening event, which has led to more individualized treatment ensuring adequate pleuromediastinal drainage with sufficient irrigation. We analyzed our data, evaluating morbidity and mortality in this selective approach. METHODS During 1985 to 2001, 17 of the 38 patients with esophageal perforation treated in our hospital underwent primarily a thoracotomy, wide drainage and debridement of chest/ mediastinum and enteral hyperalimentation. Twenty-one patients (55%) initially were treated non-operatively (NPO, nasogastric tube, hyperalimentation, antibiotics and chest tube), but surgery was required in 9 patients (43%). RESULTS Most perforations were iatrogenic (45%; 17/38) followed by spontaneous perforations (32%; 12/38). Cervical perforations were managed earlier (< 24 h) than thoracic tears, 8/10 (80%) and 17/28 (61%) respectively. Initial conservative treatment failed in all spontaneous ruptures and more in thoracic lesions (62%) than in cervical lesions (13%). Most patients with thoracic perforations and 'free' intrathoracic contamination underwent primary surgery. Surgery with adequate drainage (n = 23) was based on signs of sepsis, empyema and progression of pneumomediastinum/thorax. Mortality occurred in one patient (3%), initially treated conservatively. Median intensive care and duration of hospitalization were not different between the conservative (5 and 7 days, respectively) and the primary surgical approach (21 and 27 days, respectively), but were higher after secondary surgery (13 and 50 days, respectively). CONCLUSIONS Spontaneous esophageal perforations require early surgical exploration with drainage and irrigation of mediastinum and pleural cavity, while most iatrogenic lesions can be managed conservatively. Cervical perforations can be treated adequately non-operatively, but thoracic perforations often require surgical intervention.
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Affiliation(s)
- A I Amir
- Dept. of Surgery, University Hospital Groningen, Groningen, The Netherlands
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111
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Suc B. Complication tardive d’une hernie hiatale opérée. Journal de Chirurgie 2004; 141:157-64. [PMID: 15249887 DOI: 10.1016/s0021-7697(04)95311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- B Suc
- Service de Chirurgie Générale et Digestive Hôpital de Rangueil - Toulouse.
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112
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Shiozaki H, Shigeoka H, Imamoto H, Imano M. [Treatment of oncogenic emergencies in esophageal disease]. Nihon Geka Gakkai Zasshi 2004; 105:275-80. [PMID: 15112488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Common oncogenic emergent conditions of the esophagus are esophageal fistula with malignancy and peptic ulcer, perforation by a foreign body, and rupture (Boerhaave's syndrome) and bleeding with malignancy. The current standard of palliative therapy for patients with malignant tracheoesophageal fistula is endoscopic replacement using covered self-expandable metallic stents in the esophagus and/or trachea. We successfully treated two patients with esophageal bleeding caused by malignant ulceration. To prevent the formation of an aortoesophageal fistula, a covered self-expandable metallic stent was inserted into the esophagus and aorta. Insertion of covered self-expandable metallic stents in patients with esophageal malignancies significantly improves dysphagia, seals fistulas/perforations and ulcerations, and is associated with acceptable morbidity and mortality rates. Spontaneous esophageal rupture, also known as Boerhaave's syndrome, is a rare condition. Primary repair is appropriate for ruptures diagnosed early. Many are diagnosed late and T-tube drainage may be the simplest way to manage this difficult condition in this situation.
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Affiliation(s)
- Hitoshi Shiozaki
- Department of Surgery, Kinki University Medical School, Osaka, Japan
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113
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Abstract
Esophageal perforation is a serious complication that requires prompt recognition and treatment. We present the case of a patient with lower esophageal perforation that apparently resulted from orogastric calibration-tube passage during laparoscopic placement of a gastric band. The complication was diagnosed early postoperatively, and was able to be successfully treated by laparoscopy,debanding, drainage, and parenteral nutrition.
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Affiliation(s)
- Flavia C Soto
- The Bariatric Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
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114
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Affiliation(s)
- Gottumukkala S Raju
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas 77555-0764, USA
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115
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Abe T, Kawai N, Oshita M, Tanabe J, Wada S, Kohga K, Meren H, Masuzawa M, Kawano S. Recurrent esophageal tears. Gastrointest Endosc 2004; 59:265. [PMID: 14745405 DOI: 10.1016/s0016-5107(03)02292-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Takashi Abe
- Osaka Police Hospital, Osaka University, Osaka, Japan
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116
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Rivas S, Martínez L, Hernández F, Avila LF, Lassaletta L, Murcia J, Olivares P, Fernández A, Queizán A, López Santamaría M, Tovar JA. [Aggressive conservative treatment remains the best option for oesophageal perforation in children]. Cir Pediatr 2004; 17:3-7. [PMID: 15002717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
UNLABELLED Oesophageal perforation (OP) requires prompt and vigorous treatment. In contrast with adult patients in whom surgical closure of perforation is preferred, non-operative treatment has been the usual approach in children. The present report aims at assessing whether this strategy stands the passage of time. We studied retrospectively the charts of patients treated at our institution for OP between 1991 and 2001. Between these years, we treated 19 episodes of OP in 17 patients aged 5.3 +/- 0,94 years. In 9 cases (4 lye burns, 3 oesophageal atresias, 1 bullous epidermolysis and 1 mucocutaneous candidiasis) OP occurred during dilatation of strictures. Foreign body extraction was the cause in 3 cases, and blunt trauma and sclerosis of varices were the causes in 2 cases each. The last child had multiple gastrointestinal perforation during treatment for leukaemia. Subcutaneous emphysema was seen in 7 instances, pneumomediastinum/pneumothorax in 14, pleural effusion in 9, dyspnoea in 9, severe thoracic pain in 1 and pericardial effusion in 1. The diagnosis was intraoperative in only 2 children but the symptoms and imaging signs prompted vigorous treatment within the first 24 hours in 15 instances. One or more pleural tubes were inserted in 11 cases and pericardial drainage was required once. Perforations closed without direct surgery in 18/19 episodes (16/17 children). Five gastrotomies and 2 jejunostomies were performed and several major abdominal operations were necessary to repair concurrent lesions in a child who sustained severe blunt abdominal trauma and in the one with leukaemic perforations. All these patients survive and all recovered oesophageal function although 2 with intractable lye structures ultimately required oesophageal replacement 6 and 10 months after OP. The only patient in whom direct approach for esophageal necrosis after variceal endosclerosis was unavoidable lost her organ and had a replacement after a successful porto-systemic shunt. CONCLUSIONS Prompt and aggressive non-operative approach of oesophageal perforations in children allows survival and conservation of the organ and its function in most cases and should remain the first therapeutic choice at this age.
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Affiliation(s)
- S Rivas
- Departamento de Cirugía Pediátrica, Hospital Infantil "La Paz", Madrid
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117
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Gill SS, Dierking JM, Nguyen KT, Woollen CD, Morrow CE. Seatbelt injury causing perforation of the cervical esophagus: a case report and review of the literature. Am Surg 2004; 70:32-4. [PMID: 14964543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Blunt trauma to the head and neck is a rare cause of cervical esophageal perforation. We report a cervical esophageal perforation caused by compression by a shoulder-harness seatbelt during a high-speed motor vehicle crash. We are not aware of a similar case in the trauma literature.
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Affiliation(s)
- Satinderjit S Gill
- Division of Trauma, Department of Surgery, Spartanburg Regional Healthcare System, Spartanburg, South Carolina 29303, USA
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118
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Macrae AI, Barnes DF, Hunter HAA, Sargison ND, Scott PR, Blissitt KJ, Booth TM, Pirie RS. Diagnosis and treatment of retropharyngeal injuries in lambs associated with the administration of intraruminal boluses. Vet Rec 2003; 153:489-92. [PMID: 14601795 DOI: 10.1136/vr.153.16.489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The administration of intraruminal identification boluses to a group of 76 lambs resulted in 24 (32 per cent) showing signs of pharyngeal damage. In 16 of them the bolus was found to be in the retropharyngeal region by means of a hand-held microchip scanner, radiography and endoscopy. Purulent tracts were identified in the dorsal pharynx. In 13 of the 16 lambs the surgical removal of the bolus under general anaesthesia was followed by a normal clinical recovery, although the lambs did not grow as well as similar unaffected animals; three of the 24 lambs died. The administration of a larger bolus to 10 yearling rams did not result in any clinical signs of pharyngeal damage. The most important factors influencing the occurrence of this type of injury among this group of lambs were the size and age of the lambs, the positioning of the lambs during bolus administration, the relative size of the dosing gun and bolus, and the large number of animals in the group.
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Affiliation(s)
- A I Macrae
- Department of Veterinary Clinical Studies, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG
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119
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Abstract
A 73-year-old woman complaining of sudden hoarseness visited our hospital 17 days after the onset. The upper gastrointestinal contrast study showed a shallow ulcer crater with moderate bulging in the upper thoracic esophagus. Endoscope and computed tomography revealed an esophageal foreign body, a Press Through Pack (PTP), in the esophageal ulcer. The PTP could be removed endoscopically. Two months after extraction of the PTP, the patient was taking normal food orally and was discharged. The esophageal perforation, looking like a diverticle, was still present more than 1 year after the onset.
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Affiliation(s)
- T Sudo
- Department of Surgery, Kurume University School of Medicine, Kurume-city, Fukuoka, Japan
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120
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Abstract
Esophageal emergencies are a common problem facing practicing gastroenterologists and it is important to know what therapies are indicated for different situations. Patients ingesting caustic agents should be monitored intensively for signs of perforation and ultimately for signs of stricture development. Foreign bodies impacted in the esophagus should be removed promptly to prevent perforation. Although esophageal perforations are generally managed surgically, conservative management of localized perforations has become more common especially with improved antibiotics and the use of nonsurgical interventional drainage techniques. In either elected course the gastroenterologist should work closely with the surgical team.
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Affiliation(s)
- Marten Duncan
- Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Building 2, 7F, Washington, DC 20307-5001, USA.
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121
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Abstract
OBJECTIVE To compare the clinical course and neonatal outcomes of preterm infants with oesophageal perforation (OP). METHODS Retrospective case control study of infants admitted between 1994 and 2001 and diagnosed with OP was performed at two tertiary care centres in Toronto, Canada. One control per case was matched by the gestational age and the month of birth. Occurrence of air leak syndrome/pleural effusion requiring drainage, the duration of supplemental oxygen and the time to attain full feeds were compared. RESULTS Ten cases of OP were identified. The commonest clinical presentation was air leak syndrome/pleural effusion. There was a statistically significant increase in the time to attain full enteral feeds in OP group (P = 0.02). The duration of supplemental oxygen was prolonged in infants with OP, however, this was statistically insignificant (P = 0.20). The infants were managed conservatively and perforation healed in all. CONCLUSION Oesophageal perforation is a rare but important complication of modern neonatal intensive care setting. The diagnosis of OP should be considered in infants who present with sudden/acute deterioration in their respiratory status following procedures involving pharyngeal region. Conservative management in an otherwise uncomplicated case leads to complete recovery in neonates.
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Affiliation(s)
- P S Shah
- Departments of Paediatrics, Mount Sinai Hospital, Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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122
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Kaplan M, Mutlu EA, Jakate S, Bruninga K, Losurdo J, Losurdo J, Keshavarzian A. Endoscopy in eosinophilic esophagitis: "feline" esophagus and perforation risk. Clin Gastroenterol Hepatol 2003; 1:433-7. [PMID: 15017642 DOI: 10.1016/s1542-3565(03)00222-2] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Idiopathic eosinophilic esophagitis is an underdiagnosed disease with typical endoscopic findings, which have not been well described. METHODS Charts and pathology reports at two tertiary care centers from June 1993 to April 2002 were reviewed to describe the endoscopic findings of this disease and to correlate them with clinical characteristics. Eight patients were identified as having eosinophilic esophagitis based on clinical symptoms and pathology reports. RESULTS Soft and subtle ring(s) in the esophagus were found in 7 of 8 patients. In 3 of 8 patients, the esophagus appeared rigid. Mucosal rents occurred with simple passage of the endoscope in 5 of 8 patients. One patient developed a perforation after simple passage of the endoscope. Endoscopic findings can be normal or very subtle in these patients, and the findings can easily be missed during endoscopy. Tearing of the esophagus can occur with simple passage of the endoscope or biopsy even in the absence of overt rings. A minimum of 8 weeks of medical therapy (proton pump inhibitor, histamine antagonists, immunosuppressants) should be undertaken before considering dilation because of the high risk involved with the procedure and the good response to medical therapy. CONCLUSIONS We recommend considering dilation only in patients with eosinophilic esophagitis who do not respond to medical therapy and have rings that appear to be obstructing the lumen.
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Affiliation(s)
- Mitchell Kaplan
- Section of Gastroenterology and Nutrition, Department of Internal Medicine, Rush University, Rush Presbyterian St. Luke's Medical Center, Chicago, IL 60612-3824, USA.
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123
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Lam HCK, Woo JKS, van Hasselt CA. Esophageal perforation and neck abscess from ingested foreign bodies: treatment and outcomes. Ear Nose Throat J 2003; 82:786, 789-94. [PMID: 14606176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
Over a 6.5-year period, 5,848 patients who had ingested a foreign body were admitted to the ENT unit at the Prince of Wales Hospital in Hong Kong. Potentially serious complications developed in 12 patients (0.21%). Eight patients had an esophageal perforation; three had clinical evidence that their injury had been caused by the foreign body itself and five were deemed to have been injured iatrogenically during esophagoscopy. One of the latter group eventually developed an abscess. Four patients originally presented with an abscess. Three of these patients and the patient who later developed an abscess were treated with neck exploration and surgical drainage. One of the patients who initially presented with an abscess refused surgical treatment and was treated conservatively. Conservative treatment was also initiated for all patients who had a perforation. Patients on the conservative regimen were administered intravenous broad-spectrum antibiotics and were not permitted to take any food or liquids by mouth; they received their nutrition via either enteral feeding or total parenteral nutrition. Conservative treatment was successful in all seven patients with a perforation and no abscess and in the one patient with an abscess who refused surgery. Moreover, all four patients who underwent surgical treatment recovered. Our experience demonstrates that esophageal perforation related to an ingested foreign body can be safely treated by conservative means if the diagnosis is made before significant contamination occurs. Conversely, abscesses (cervical or mediastinal) related to an ingested foreign body should be explored and surgically drained.
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Affiliation(s)
- Henry Chuen Kwong Lam
- Division of Otorhinolaryngology, Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong
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124
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Moons LM, Kuipers EJ, Siersema PD. [Acute dysphagia: often there is a readily treatable cause]. Ned Tijdschr Geneeskd 2003; 147:1713-7. [PMID: 14520793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Three patients, one woman aged 45 years and two men aged 40 and 62 years, presented with acute dysphagia due to oesophageal obstruction by a piece of food. In the woman symptoms of oesophageal perforation developed after the piece of food was removed by rigid endoscopy; she recovered after treatment with a stent, antibiotics and acid inhibitors. The younger man had a stricture of the oesophagus that was dilated. The older man had a Barrett's oesophagus and also oesophagcal adenocarcinoma; he was free of symptoms three years after resection of the oesophagus and the creation of a tubular stomach. In adults, 60% of acute oesophageal obstructions are caused by food impaction, which is associated with a high incidence of secondary pathologic findings in the oesophagus (75-97%). Evaluation of the oesophagus by flexible endoscopy contributes to an adequate diagnosis. Moreover, it can be used to treat the cause of the obstruction. If dilation therapy is started early after detecting a benign stricture in the oesophagus, it reduces the likelihood of recurrence. The detection of early-stage oesophageal malignancies may improve the prognosis of patients with this disorder.
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Affiliation(s)
- L M Moons
- Erasmus Medisch Centrum, locatie Dijkzigt, afd. Maag-, Darm- en Leverziekten, Postbus 2040, 3000 CA Rotterdam.
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125
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Abstract
BACKGROUND Surgery for traumatic, non-malignant perforation of the esophagus in patients presenting more than 24 hours after its occurrence carries a high morbidity and mortality. Covered metallic stents have been used to effectively seal perforations in individual patients with Boerhaave's syndrome. METHODS Eleven consecutive patients presented with esophageal perforation that was caused by Boerhaave's syndrome (n = 5), resection of an epiphrenic diverticulum (n = 2), rigid esophagoscopy (n = 2), extended gastric resection (n = 1), or pneumatic dilation for achalasia (n = 1). A large diameter Flamingo Wallstent (proximal/distal diameters, 30/20 mm) (7 patients) or a large diameter Ultraflex stent (proximal/distal diameters, 28/23 mm) (4 patients) was placed. Pleural cavities were drained with thoracostomy drains, and antibiotics were administered. RESULTS The median time from perforation to stent insertion was 60 hours (range, 24 hours to 28 days). The perforation was totally sealed in 10 of 11 patients. Two patients underwent esophageal resection because of incomplete sealing of the perforation or incomplete drainage of the pleural cavity and mediastinum. The other 9 patients recovered uneventfully and resumed a normal diet within 7 to 18 days. In 7 patients, the stents were retrieved endoscopically after a median of 7 weeks (range, 6 to 14 weeks), whereas two patients refused to have the stent retrieved (in one, the stent migrated into the stomach; the other patient died 6 months after stent placement from an unrelated cause). CONCLUSIONS Traumatic perforation of the esophagus can be treated successfully with large diameter metallic stents, together with adequate drainage of the thoracic cavity.
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Affiliation(s)
- Peter D Siersema
- Department of Gastroenterology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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126
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Chung CH. Subtle perforation of the oesophagus by a foreign body. Hong Kong Med J 2003; 9:290-2. [PMID: 12904618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
A case of subtle oesophageal perforation caused by a foreign body is described. A 48-year-old woman had had a chicken bone impacted in the upper oesophagus for 4 days. At presentation, the bone was dislodged at endoscopy, and two small round depressions at opposite sides of the oesophageal wall were visible. The chest X-ray findings were normal. Computed tomography of the thorax detected a small amount of air in the mediastinum. The water-soluble contrast swallow test showed no evidence of leakage. The patient was successfully treated using conservative measures.
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Affiliation(s)
- C H Chung
- Accident and Emergency Department, North District Hospital, 9 Po Kin Road, Sheung Shui, Hong Kong.
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127
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Abstract
STUDY DESIGN Five cases of esophageal or pharyngeal perforation diagnosed during or after anterior cervical spine surgery are presented. OBJECTIVE To outline a protocol for the early diagnosis and treatment of iatrogenic pharyngoesophageal perforations. SUMMARY OF BACKGROUND DATA Pharyngoesophageal perforations after anterior cervical spine surgery are uncommon or rarely reported complications. They may have serious functional consequences, including death, if they are not diagnosed promptly and treated effectively. These potentially fatal conditions require a surgical and medical therapy. METHODS Clinical course, diagnostic tools and guidelines for the management of five patients presenting esophagopharingeal perforations are illustrated. RESULTS These five cases resulted in definitive healing of the laceration without functional consequences. CONCLUSION We believe that awareness of these complications and their causes, prompt recognition of the symptoms and immediate and multimodality therapies are essential tools to achieve successful results.
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Affiliation(s)
- Epimenio Ramundo Orlando
- University of Rome La Sapienza, Department of Neurological Sciences II Chair of Neurosurgery, Rome, Italy
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128
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Abstract
The usefulness and safety of transesophageal echocardiography during cardiac surgery have been well described in the literature. However, rare complications of this procedure can occur and should be familiar to surgeons and anesthesiologists. A case of esophageal perforation by echoprobe during coronary artery bypass grafting treated successfully by endoscopic stenting is reported.
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Affiliation(s)
- Albert M Nana
- Department of Cardiac Surgery, Erasme Hospital, University of Brussels, Brussels, Belgium
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129
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Abstract
BACKGROUND Perforations of the hypopharynx and the cervical oesophagus are infrequent severe situations, which may even be life-threatening for patients. METHODS We review seven cases of intraluminal perforations of the hypopharynx or cervical oesophagus treated at our department between 1999 and 2001. RESULTS In this series of patients, foreign bodies were the main cause of perforation. In four cases, the treatment was surgical by means of a cervicotomy and/or thoracotomy and drainage; in the other three cases, conservative treatment was applied. In some cases, the morbidity was considerable but there were no mortalities. CONCLUSIONS The treatment of perforations of the hypopharynx and the cervical oesophagus must be individualized and multidisciplinary. The early diagnosis of these perforations is an important factor for prognosis.
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Affiliation(s)
- Adolfo G Hinojar
- Department of Otorhinolaryngology, Hospital de la Princesa, Universidad Autónoma de Madrid, Diego de León 62, Spain.
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130
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Abstract
Esophageal perforation is a serious condition with a high mortality rate. Successful therapy depends on the size of the rupture, the time elapsed between rupture and diagnosis, and the underlying health of the patient. Common causes of esophageal perforation include medical instrumentation, foreign-body ingestion, and trauma. A case of esophageal perforation due to fish bone ingestion in a 70-year-old diabetic male is described here, with a review of the pertinent literature. The patient presented with odynophagia after a meal that included fish. Initial evaluation was nondiagnostic and the patient was discharged home. The patient returned 12 days later with fever, generalized weakness, and persistent dysphagia. Esophageal biopsy of a necrotic ulcer revealed foreign material with acute inflammatory changes. Computed tomography scan demonstrated a pneumomediastinum. The patient became hemodynamically unstable and died on the third hospital day.
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Affiliation(s)
- Manny C Katsetos
- Internal Medicine Residency Program, and Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT 06102-5037, USA.
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131
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Abstract
OBJECTIVE The diagnosis and management of oesophageal perforation continues to challenge clinicians. We present our experience of perforated oesophagus in a Tertiary Referral Centre for Thoracic and Oesophageal Surgery. METHODS Between 1985 and 2000, 75 patients (40 male) with oesophageal perforation were treated in out unit; age range 24-89, median 63. Retrospective review of these cases has been performed. RESULTS There were 12 deaths (16%). With increases in time from perforation to diagnosis, there was a stepwise increase in the mortality rate. Immediate diagnosis 5%; early diagnosis (1-24h) 14%; late diagnosis (>24h) 44% (P>or=0.002). Site of perforation, aetiology, and treatment strategy had no influence on mortality. The only independent predictor of mortality identified was time to diagnosis from perforation (beta 0.429, P=0.001). Time to definitive management in those undergoing an operative procedure had no influence on outcome with multivariate analysis. CONCLUSIONS Prompt recognition of the diagnosis of oesophageal perforation and rapid institution of supportive measures, followed by an appropriate, patient specific treatment option optimises the chance of a successful outcome. The wide range of presentation of oesophageal perforation necessitates individualisation of treatment.
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Affiliation(s)
- A D Muir
- Department of Thoracic Surgery, Royal Victoria Hospital, Belfast, Northern Ireland, UK
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132
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Martinez L, Rivas S, Hernández F, Avila LF, Lassaletta L, Murcia J, Olivares P, Queizán A, Fernandez A, López-Santamaría M, Tovar JA. Aggressive conservative treatment of esophageal perforations in children. J Pediatr Surg 2003; 38:685-9. [PMID: 12720170 DOI: 10.1016/jpsu.2003.50183] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND/PURPOSE In contrast with adult patients in whom surgical closure of the defect is preferred, nonoperative treatment has been the usual approach for esophageal perforation (EP) in children. This report aims to assess whether this strategy stands the passage of time. METHODS We reviewed retrospectively the charts of 17 patients aged 5.3 +/- 0.9 years (mean +/- SD) treated at our institution for EP between 1991 and 2001. RESULTS Nineteen episodes of EP were caused by stricture dilation in 9 cases, foreign body extraction in 3, and blunt trauma and sclerosis of varices in 2 cases each. The remaining child had multiple gastrointestinal perforations in the course of chemotherapy for leukemia. Vigorous treatment, consisting of nasopharyngeal aspiration, wide spectrum antibiotics, prompt drainage of effusions and either parenteral or infraesophageal nutritition, was implemented immediately after diagnosis. Perforations were closed without direct surgery in 18 of 19 episodes (16 of 17 children). One or more pleural drains were inserted in 12 cases, and pericardial drainage was required once. Seven gastrostomies, 2 jejunostomies, and one esophagostomy were performed. Several major abdominal operations were necessary to repair concomitant lesions in a child who sustained severe blunt abdominal trauma and in the patient with leukemic perforations. All patients survived, and all recovered esophageal function. However, 2 with intractable lye strictures ultimately required esophageal replacement. The only patient in whom a direct approach for esophageal necrosis due to variceal endosclerosis was unavoidable, lost her organ and had a retrosternal colonic interposition after a successful portosystemic shunt. Excluding patients with other concomitant lesions and the patient who underwent surgery, median length of stay was 11 days (range, 6 to 47). CONCLUSIONS Prompt and aggressive nonoperative treatment of esophageal perforations in children allows survival with conservation of the organ in most cases and remains, in the authors' hands, the first therapeutic choice at this age.
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Affiliation(s)
- L Martinez
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
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133
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Abstract
We herein report about a case of perforation of the cervical esophagus by an artificial denture, which had been swallowed by the patient after a horse-related-injury. Impactation of the foreign body at the level of the upper esophageal sphincter was followed by its penetration through the esophageal wall, causing severe infection of the cervical soft tissue, mediastinitis and sepsis. We discuss the well-known phenomena of prosthesis ingestion and frequently delayed diagnosis, as well as our treatment strategy of cervical esophageal perforation with placement of a T-tube into the cervical esophagus and mediastinal drainage.
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134
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van Looij MAJ, Feenstra L. [Two patients with a perforation of the esophagus and hypopharynx, respectively, caused by a bone in their food]. Ned Tijdschr Geneeskd 2003; 147:714-7. [PMID: 12722535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Two patients, men aged 58 and 28 years, developed pain in the throat while eating chicken and pork, respectively. In the emergency clinic and during a check-up on the following day, no foreign body could be found. On the third visit to the hospital, oesophagoscopy was performed. In one patient a chicken bone was found lying transversely in the oesophagus; after removal of this bone extraluminal pus was seen. In the other patient a pork bone was found in the right piriform recess, with a great deal of local pus. Both foreign bodies were removed during oesophagoscopy. The recovery of both patients was uneventful. A foreign body is found in the upper digestive tract in approximately one-third of the patients presenting to an emergency department with a history of foreign body ingestion. Serious complications occur in less than 1%; however, these complications can be life-threatening. If, based on the anamnesis, physical examination or radiological evaluation, there is suspicion of a foreign body in the oesophagus, or if the examination is incomplete, then oesophagoscopy should be performed.
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Affiliation(s)
- M A J van Looij
- Erasmus Medisch Centrum, afd. KNO, dr.Molewaterplein 40, 3015 GD Rotterdam
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135
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Abstract
BACKGROUND Perforation of the thoracic esophagus is a formidable challenge. Treatment and outcome are largely determined by the time to presentation. We reviewed our experience with esophageal perforations to determine the overall mortality and whether the time to presentation should influence management strategy. METHODS A retrospective chart review was performed on all patients treated for perforation of the thoracic esophagus from 1990 to 2001. There were 26 patients (14 men and 12 women; median age, 62 years; range, 36 to 89 years). Fourteen patients presented within 24 hours (early), and 12 patients presented after 24 hours (delayed). Nine of the 12 patients in the delayed group presented after 72 hours. The causes of the perforations were as follows: instrumentation (19 patients), Boerhaave's syndrome (2 patients), intraoperative injury (1 patient), and other (4 patients). In the early group, 3 patients were treated conservatively, 10 patients underwent primary repair, and 1 patient required esophagectomy for carcinoma. In the delayed group, 3 patients were treated conservatively, 6 underwent successful repair of the perforation, 1 had a T-tube placement through the perforation and eventually required an esophagectomy, and 2 had an esophagectomy as primary surgical treatment. RESULTS Hospital mortality was 3.8% (1 of 26) and morbidity was 38% (10 of 26). Persistent leaks occurred in 3 patients, 2 after primary repair and 1 after T-tube drainage. All patients selected for conservative management successfully healed their perforation. CONCLUSIONS Primary repair can be carried out in most cases of thoracic esophageal perforation regardless of time to presentation, with a low mortality rate. A small but carefully selected group of patients may be treated successfully without operation. Esophagectomy should be reserved for patients with carcinoma or extensive necrosis of the esophagus.
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Affiliation(s)
- Jeffrey L Port
- Department of Cardiothoracic Surgery, Weill-Cornell Medical Center, New York, New York 10021, USA
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136
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Abstract
AIM OF THE STUDY To analyze treatment and prognosis of perforations and ruptures of the oesophagus. MATERIAL AND METHODS This retrospective study included 40 patients (26 men and 14 women; mean age = 59 +/- 17 years) with a perforation or a rupture of the oesophagus. Seven perforations were cervical: iatrogenic (n = 6) or following ingestion of a foreign body (n = 1). Thirty-three perforations were thoracic: iatrogenic (n = 15), spontaneous rupture (n = 14), following ingestion of foreign body (n = 3) or traumatic (n = 1). All patients with cervical perforations were operated on (suture or drainage). One patient with thoracic perforation died before surgery, 2 underwent non-operative treatment and 30 were operated on. Twenty-eight underwent an oesophageal procedure: suture (n = 13), oesophagectomy (n = 11) or double exclusion (n = 4). Two uderwent surgery without oesophageal procedure (one pleural decortication, and one ablation of a pleural foreign body). RESULTS The overall mortality rate was 17% (7/40), 21% (3/14) after spontaneous ruptures and 19% (4/21) after iatrogenic perforations (no death for other aetiologies). The mortality rate was 14% (1/7) for cervical lesions and 18% (6/33) for thoracic ones. It was 8% (1/13) after intrathoracic suture, 18% (2/11) after oesophagectomy and 50% (2/4) after double exclusion. CONCLUSION Iatrogenic perforation and spontaneous rupture had the same poor prognosis. Non-surgical treatment is rarely indicated. oesophagectomy is a good option in case of non suturable oesophagus or delayed operation.
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Affiliation(s)
- N Cheynel
- Service de chirurgie digestive, thoracique et cancérologique, centre hospitalier universitaire du Bocage, 2, avenue Maréchal-de-Lattre-de-Tassigny, BP 77908, 21079 cedex, Dijon, France
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137
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Mussack T, Landauer N, Ladurner R, Schiemann U, Goetzberger M, Burchardi C, Folwaczny C, Heldwein W, Hallfeldt K. Successful treatment of cervical esophageal perforation in Behcet's disease with drainage operation and infliximab. Am J Gastroenterol 2003; 98:703-4. [PMID: 12650819 DOI: 10.1111/j.1572-0241.2003.07317.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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138
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Lana Soto R, Mendoza Hernández JL, Arranz García F, Nieto Sánchez A, Cuervo Molinero C, Jiménez de Diego L. [Spontaneous rupture of the esophagus: diagnostic problem in the emergency service]. An Med Interna 2003; 20:88-90. [PMID: 12703163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
We present two case of a spontaneous perforation of the esophagus (Boerhaave's syndrome), they were associated with different symptoms. Both of them the diagnosis was make on the second admission to the emergency service. The Boerhaave's syndrome is potentially lethal, relatively rare and the difficult diagnosis in the initial phases. It's a life threatening condition demanding early diagnosis and rapid aggressive management to prevent fulminant death.
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Affiliation(s)
- R Lana Soto
- Unidad de Aparato Digestivo, Fundación Hospital Alcorcón, Servicio de Urgencias, Hospital Clinico San Carlos, Madrid
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139
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Nérot C, Jeanneret B, Lardenois T, Lépousé C. Esophageal perforation after fracture of the cervical spine: case report and review of the literature. J Spinal Disord Tech 2002; 15:513-8. [PMID: 12468980 DOI: 10.1097/00024720-200212000-00014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present a posttraumatic esophageal tear that occurred in a 55-year old patient after a truck accident. He sustained a two-level injury with a type II odontoid fracture and a unilateral fracture of the left superior articular process of C6 with an incomplete quadriplegia at C5. Both lesions were treated nonoperatively. The tear was attributed to the stretching of the esophagus over anterior degenerative spurs at the level of the lesion (C5-C6) during hyperextension. The diagnosis of the esophageal perforation was delayed for 6 days. The treatment consisted of surgical debridement, volume expansion, antibiotic therapy, hyperbaric oxygenation, assisted ventilation, and esophageal exclusion. A complete review of the literature was performed.
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Affiliation(s)
- C Nérot
- Department of Orthopedics, Hôpital Maison Blanche, Reims, France
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140
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Soman R, Gohar S. Boerhaave's syndrome in pregnancy. J Assoc Physicians India 2002; 50:1456-7. [PMID: 12583491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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141
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Eriksen JR. Palliation of non-resectable carcinoma of the cardia and oesophagus by argon beam coagulation. Dan Med Bull 2002; 49:346-9. [PMID: 12553168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
INTRODUCTION The aim of this study was to describe the argon beam coagulation (ABC) technique in the palliative treatment of patients with nonresectable carcinoma of the cardia and oesophagus and this treatments needs, complications and tolerance. METHODOLOGY A retrospective evaluation of 31 patients referred for palliation by ABC over a period of nearly four years (1.1.98-31.8.01). RESULTS Twenty-two men and nine women, median age 72 years (range 49-91 years), underwent a total of 163 treatments and a median of five treatments per patient (range 1-18). Recanalisation enabling passage of the scope was achieved in 89% of treatments, and most of these patients had dysphagia grade = 2. The median range between reinterventions was 25 days (range 1-175 days). Perforation was seen in three patients and in 1.8% of treatments; procedure related mortality was 1.2%. The median hospital stay for every treatment was two days (range 1-27 days) and the median inpatient stay as a proportion of survival time was 8%. The median survival was 190 days (range 7-612 days) with the 1-year survival 19%. DISCUSSION ABC is a well-tolerated, safe and effective treatment in patients with non-resectable cancer of the oesophagus or cardia and offers an acceptable complication rate and number of reinterventions compared with laser and stent placement. The technique is easy and cheap, and requires no further restrictions than conventional monopolar electro coagulation does. Prospective randomised trials comparing the efficacy of the different palliative treatments for patients with oesophagogastric cancer are needed.
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142
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Scatton O, Gaudric M, Massault PP, Chaussade S, Houssin D, Dousset B. [Conservative management of esophageal perforation after pneumatic dilatation for achalasia]. Gastroenterol Clin Biol 2002; 26:883-7. [PMID: 12434098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
PURPOSE To assess the results and indications of conservative management of esophageal perforation following pneumatic dilatation for achalasia. PATIENTS AND METHODS Thirteen esophageal perforations complicating 524 dilatations in 412 patients (3%) were diagnosed by esophagogram. Medical treatment consisted of nasogastric succion, antibiotics and pleural drainage, if necessary. Conservative surgical treatment included left thoracophrenotomy, perforation closure, controlateral myotomy and anterior fundoplication. Surgical decision was based upon clinical and radiological parameters. Functional outcome was assessed by the means of the Eckardt's grading score. RESULTS Six patients were successfully managed by medical treatment. Seven patients underwent conservative surgery, three of whom after failure of medical treatment. The presence of a pneumomediastinum at initial presentation led to immediate (n=2) or delayed (n=2) surgery in all instances. No patients died. In the surgical group, morbidity consisted of one wound infection, one pleural effusion and one venous thrombosis. One severe chest infection occurred in the medical group. Oral feeding was reintroduced after a median of 10 and 11 days in the surgical and medical groups, respectively. Functional results were satisfactory and similar in both groups. CONCLUSION Conservative medical or surgical management of oesophageal perforation following pneumatic dilatation is safe, if the diagnosis is done early. Pneumomediastinum at initial presentation seems to predict failure of conservative medical treatment.
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143
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Bogliolo G, Ierfone N, Brini C, Di Fulvio A, Stragapede RA, Martino G, Grimaldi F. [Esophageal perforations and fistulas: clinical management]. G Chir 2002; 23:394-400. [PMID: 12611263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Aim of this study was the literature review regarding esophageal perforations and fistulas. We examined the most common causes, clinical findings (symptoms and signs), laboratory and imaging studies for differential diagnosis and complications. Finally, we examined the surgical or endoscopic treatment and the prognosis.
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Affiliation(s)
- G Bogliolo
- Dipartimento di Scienze Chirurgiche, Università degli Studi La Sapienza, Roma
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144
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Abstract
BACKGROUND AND STUDY AIMS Perforations during endoscopic retrograde cholangiopancreatography (ERCP) are rare, and the management of these perforations is variable, with some patients requiring immediate surgery and others only conservative management. We reviewed all ERCP-related perforations at our institution to determine: a) their incidence; b) clinical outcomes; c) which management approaches gave the best results; and d) which factors predict a perforation. PATIENTS AND METHODS All patients who underwent ERCP and suffered perforation were reviewed. To compare the length of hospital stay of the perforation group with that of patients suffering a different complication, patients who developed post-ERCP pancreatitis were also reviewed. To evaluate predictors of ERCP-related perforations, three groups were compared: group 1 (n = 49), normal ERCP/no complications; group 2 (n = 52), ERCP complicated by pancreatitis; and group 3 (n = 33), ERCP with perforation. RESULTS Of 33 patients with confirmed ERCP-related perforations, only seven patients required surgical intervention. The overall length of hospital stay (6.5 +/- 3.5 days) was significantly longer (P = 0.003) than that of a random group of patients with the complication of post-ERCP pancreatitis (4.7 +/- 2.6 days). According to univariate analysis, risk factors included: sphincterotomy (odds ratio [OR] 9.0, 95 % confidence interval [CI] 3.2 - 28.1); sphincter of Oddi dysfunction (OR 3.8, 95 % CI 1.4 - 11.0); and dilated common bile duct (OR 4.07, 95 % CI 1.63 - 10.18, P = 0.003). In the multivariate logistic regression analysis, additional predictive factors included the duration of procedure (OR 1.021, 95 % CI 1.006 - 1.036), and biliary stricture dilation (OR 7.2, 95 % CI 1.84 - 28.11). CONCLUSIONS (i) The incidence of ERCP-related perforations is very low (0.35 %). (ii) Esophageal, gastric and duodenal perforations usually require surgery, but sphincterotomy- and guide wire-related perforations rarely do so. (iii) Factors which carry increased risk of an ERCP-related perforation include suspected sphincter of Oddi dysfunction, greater age, a dilated bile duct, sphincterotomy, and longer duration of the procedure.
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Affiliation(s)
- R Enns
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, Canada.
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145
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Hinojar AG, Castejón MAR, Hinojar AA. Conservative management of a case of cervical esophagus perforation with mediastinal abscess and bilateral pleural effusion. Auris Nasus Larynx 2002; 29:199-201. [PMID: 11893458 DOI: 10.1016/s0385-8146(01)00145-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Perforation of the cervical esophagus is a serious circumstance. Mediastinitis secondary to esophageal perforations is associated with high mortality. There is a lack of consensus on the optimal treatment for this condition. We present a case of conservative treatment in an 82-year-old woman with cervical esophagus rupture associated with mediastinal abscess and bilateral pleural effusion resulting from dilatation of a malignant esophageal stricture. Conservative treatment consisted on broad-spectrum intravenous antibiotic therapy, antireflux measures and gastrostomy was satisfactory. Treatment of the esophageal perforation should be individualized to the circumstances of each patient. Advances in antibiotic and nutritional therapy, early institution of treatment and observance of the indications, made possible a more frequent use of a conservative therapeutic approach.
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Affiliation(s)
- Adolfo G Hinojar
- Department of Otorhinolaryngology, Hospital de la Princesa, Diego de León 62, 28006, Madrid, Spain.
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146
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Perea García J, Turégano Fuentes F, Escat Cortés JL, Valcarce M. [Non-surgical conservative treatment of thoracic esophageal perforations]. Rev Esp Enferm Dig 2002; 94:105-7. [PMID: 12185649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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147
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Abstract
OBJECTIVE Timely and experienced intervention for esophageal foreign bodies generally allows for removal with minimal morbidity. However, esophageal foreign bodies present a risk for esophageal perforation and subsequent mediastinitis, especially if the diagnosis of the foreign body is delayed. Although much has been written about the management of esophageal foreign bodies and their complications, little has been mentioned in recent literature about the specific complication of mediastinitis. This review was performed to examine our experience with this uncommon complication of esophageal foreign bodies. METHODS A retrospective review of the esophageal foreign body database at Children's Hospital of Wisconsin from 1987 to 1997 was performed to identify patients with esophageal foreign bodies and subsequent mediastinitis. RESULTS Four patients with esophageal perforation with associated mediastinitis secondary to retained esophageal foreign bodies were identified. Three of the four patients were treated with conservative measures consisting of foreign body removal, intravenous antibiotics and discontinuing of oral nutrition. These patients all achieved resolution of their mediastinitis and esophageal perforation with subsequent return to normal diets and no significant morbidity. One patient, with vascular erosion, required aggressive, invasive therapy. CONCLUSION From review of this limited number of patients, in the absence of major vascular erosion, conservative methods of treating children with foreign body esophageal perforation and subsequent mediastinitis appears to be effective.
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Affiliation(s)
- J E Kerschner
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Children's Hospital of Wisconsin, 9000 West Wisconsin Avenue, Box 1997, Milwaukee, WI 53021, USA.
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148
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Abstract
Esophageal perforation after cervical spine surgery is a rare complication. Based on the case of a 77-year-old female patient with a late, asymptomatic esophageal perforation after a ventral spondylodesis of the cervical spine, the symptoms, diagnostics, and therapy of this complication are discussed. The therapy of choice is the operation. Nonoperative therapy should only be chosen--like in our case--for special indications. An esophageal perforation with symptoms should be treated operatively. Our patient was treated conservatively in consideration of her age and missing symptoms.
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Affiliation(s)
- C A Müller
- Abteilung für Unfall-, Hand- und Wiederherstellungschirurgie, Städtisches Klinikum Karlsruhe.
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149
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Keszler P. [Let's learn the Hungarian medical literature]. Orv Hetil 2001; 142:539. [PMID: 11288382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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150
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Abstract
Spontaneous esophageal perforations are associated with a high mortality and morbidity without surgery. The treatment mortality for early (<24) and late (>24 h) spontaneous esophageal perforations is reviewed as well as all recent cases of chronic spontaneous esophageal perforations. Chronic esophageal perforations with mediastinal cavities may be best treated by internal drainage of the cavity into the esophagus in order to convert the transmural perforation into an intramural esophageal dissection.
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Affiliation(s)
- C J McNamee
- Department of Surgery, University of Alberta, Edmonton, Canada.
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