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Shaqran TM, Engineer R, Abdalla EM, Alamoudi AA, Almahdi R, Aldhahri A, Alghamdi AM, Abufarea BM, Almutairi RF, Al-Suliman AA. The Management of Esophageal Perforation: A Systematic Review. Cureus 2024; 16:e63651. [PMID: 39092389 PMCID: PMC11293018 DOI: 10.7759/cureus.63651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 08/04/2024] Open
Abstract
Esophageal perforation, a rare and serious condition, has seen a reduction in mortality from 30% to 15% over the last three decades due to advancements such as gastrointestinal stents, minimally invasive surgeries, and improved interventional radiology techniques. This review analyzes management strategies for esophageal perforation based on 14 English-language articles published from 2009 to 2024, primarily utilizing surveys and national database analyses. The management of esophageal perforation is complex, with challenges in diagnosis and treatment strategy. Despite surgery being the traditional treatment, the role of less invasive methods is growing. Effective management of esophageal perforation involves advanced imaging for diagnosis, hemodynamic stabilization, and a multidisciplinary approach to treatment, including surgical and non-surgical interventions. The evidence for different treatment outcomes remains limited, highlighting the need for comprehensive care involving thoracic surgery, interventional radiology, gastroenterology, and critical care in an intensive care unit setting.
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Affiliation(s)
- Tariq M Shaqran
- Family Medicine, King Salman Armed Forces Hospital, Tabuk, SAU
| | | | - Esra M Abdalla
- Family Medicine, Michigan State University, East Lansing, USA
| | | | - Reham Almahdi
- College of Medicine, Al Baha University, Al Baha, SAU
| | - Ahmed Aldhahri
- Medicine and Surgery, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | | | - Bashair M Abufarea
- Medicine and Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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Lee CM, Kim SJ. [A Giant Gastric Perforation Occurring in the Normal Mucosa during Endoscopy in a Patient with Advanced Gastric Cancer]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2024; 83:65-68. [PMID: 38389463 DOI: 10.4166/kjg.2023.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024]
Abstract
The incidence of giant gastric perforation occurring during upper gastrointestinal endoscopy is exceedingly rare. Gastric perforation can arise from excessive air insufflation and is more prevalent in elderly patients with atrophic gastritis. Although giant gastric mucosal lacerations during diagnostic endoscopy have occasionally been reported, there are few reports of giant gastric perforation. The authors experienced a giant gastric perforation occurring in the normal mucosa during endoscopy in an 81-year-old woman with advanced gastric cancer. The patient had reduced gastric extensibility due to the advanced gastric cancer surrounding the entire lower part of her stomach. During continuous air insufflation, only the upper part of the stomach became overdistended, resulting in mucosal rupture and perforation. In addition, old age and the presence of atrophic gastritis contributed to the increased risk of mucosal rupture. The patient was treated successfully with endoscopic clips. This paper reports this case with a review of the relevant literature.
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Affiliation(s)
- Cheol Min Lee
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Su Jin Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Grosse Meininghaus D, Freund R, Heimbaecher L, Kleemann T, Kushnir A, Geller JC. Incidence and clinical relevance of upper gastrointestinal pathology during preprocedural endoscopy in patients undergoing pulmonary vein isolation. Clin Res Cardiol 2022; 111:1069-1076. [PMID: 35716196 DOI: 10.1007/s00392-022-02050-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/31/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Reflux-induced esophagitis might facilitate ablation-induced esophageal lesions (ELs) following pulmonary vein isolation (PVI), and these may progress to atrio-esophageal fistula (AEF). In contrast, preexisting ELs are not prone to progression but may affect procedure planning. OBJECTIVE To study the incidence of preexisting esophageal and upper gastrointestinal (UGI) pathology in patients undergoing PVI, and the relation to ablation-induced ELs. METHODS From 08/2018 to 09/2021, consecutive patients undergoing (radiofrequency [RF] or cryoballoon [CB]) PVI were examined by esophagogastroscopy (EGD) before and following ablation. Postprocedural endoscopic ultrasound (EUS) was added in 2021. RESULTS 412 patients (median age 67.5 [IQR 61.3-75.0] years, 56.1% male) were studied. Preprocedural EGD showed abnormalities in 226/399 patients, 15% in the lower third of the esophagus. Half (99/226) were relevant for PVI, 13 procedures were postponed, 6 due to pathological EGD results. A third of the patients with new esophageal injury following ablation had preexisting esophagitis which was associated with a trend for a higher incidence of ELs after RF ablation (12.5 vs. 6.9%, p = 0.232), and a six- and two-fold higher rate of food retention after CB-PVI (28.6 vs. 4.5%, p = 0.008) and RF ablation (8.3 vs. 4.4%, p = 0.279), respectively. CONCLUSION (1) EGD before PVI showed UGI abnormalities in > 50% of patients, one-fourth of these relevant for PVI. (2) Esophageal inflammation was associated with a higher incidence of post-ablation (peri)-esophageal injury. Whether having this information before ablation is able to reduce ELs or AEF remains to be shown.
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Affiliation(s)
- Dirk Grosse Meininghaus
- Department of Cardiology, Carl-Thiem-Hospital Cottbus, Thiemstr. 111, 03048, Cottbus, Germany.
| | - Robert Freund
- Thiem Research, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Lukas Heimbaecher
- Department of Cardiology, Carl-Thiem-Hospital Cottbus, Thiemstr. 111, 03048, Cottbus, Germany
| | - Tobias Kleemann
- Department of Gastroenterology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Anton Kushnir
- Department of Radiology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - J Christoph Geller
- Arrhythmia Section, Division of Cardiology, Zentralklinik Bad Berka, Bad Berka, Germany.,Otto-Von-Guericke University School of Medicine, Magdeburg, Germany
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4
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Two-stage surgery for delayed esophageal perforation and concomitant chylothorax secondary to upper gastrointestinal endoscopy. Ann Med Surg (Lond) 2022; 77:103623. [PMID: 35637995 PMCID: PMC9142553 DOI: 10.1016/j.amsu.2022.103623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/10/2022] [Accepted: 04/10/2022] [Indexed: 11/20/2022] Open
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Mili T, Chibani I, Charieg A, Marzouki M, Ben Ahmed Y, Boukesra T, Nouira F, Jlidi S. Endoscopic Vacuum Therapy for iatrogenic esophageal perforation in a child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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6
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Bahloul A, Hammami R, Bougharriou A, Charfeddine S, Smaoui R, Abid L, Kammoun S. An exceptional complication of transesophageal ultrasound in a patient with Coronavirus disease. Clin Case Rep 2021; 9:2336-2339. [PMID: 33936690 PMCID: PMC8077351 DOI: 10.1002/ccr3.4030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 11/08/2022] Open
Abstract
EP after TEE represents a medico-surgical emergency. Given the high rate of asymptomatic patients with COVID 19, the risk of contamination and the frailty of esophageal tissues, we should check coronavirus infection in every patient before TEE.
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Affiliation(s)
- Amine Bahloul
- Department of CardiologyHedi Chaker HospitalSfaxTunisia
| | - Rania Hammami
- Department of CardiologyHedi Chaker HospitalSfaxTunisia
| | | | | | - Racha Smaoui
- Department of CardiologyHedi Chaker HospitalSfaxTunisia
| | - Leila Abid
- Department of CardiologyHedi Chaker HospitalSfaxTunisia
| | - Samir Kammoun
- Department of CardiologyHedi Chaker HospitalSfaxTunisia
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7
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Freitas-Ferraz AB, Bernier M, Vaillancourt R, Ugalde PA, Nicodème F, Paradis JM, Champagne J, O’Hara G, Junquera L, del Val D, Muntané-Carol G, O’Connor K, Beaudoin J, Rodés-Cabau J. Safety of Transesophageal Echocardiography to Guide Structural Cardiac Interventions. J Am Coll Cardiol 2020; 75:3164-3173. [DOI: 10.1016/j.jacc.2020.04.069] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/09/2020] [Accepted: 04/23/2020] [Indexed: 11/30/2022]
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8
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Chen S, Shapira-Galitz Y, Garber D, Amin MR. Management of Iatrogenic Cervical Esophageal Perforations. JAMA Otolaryngol Head Neck Surg 2020; 146:488-494. [DOI: 10.1001/jamaoto.2020.0088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Sophia Chen
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
| | - Yael Shapira-Galitz
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
| | - David Garber
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
| | - Milan R. Amin
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
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9
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Lampridis S, Mitsos S, Hayward M, Lawrence D, Panagiotopoulos N. The insidious presentation and challenging management of esophageal perforation following diagnostic and therapeutic interventions. J Thorac Dis 2020; 12:2724-2734. [PMID: 32642181 PMCID: PMC7330325 DOI: 10.21037/jtd-19-4096] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Diagnostic and therapeutic interventions on the esophagus or adjacent organs are responsible for nearly half of all esophageal perforations. If not recognized at the time of the injury, iatrogenic esophageal perforations can present insidiously and lead to delay in diagnosis, thereby increasing morbidity and mortality. Acute clinical awareness is vital for prompt diagnosis, which is usually confirmed with contrast esophagography and contrast-enhanced computed tomography. After establishment of diagnosis, treatment should be promptly initiated and include fluid-volume resuscitation, cessation of oral intake, nasogastric tube insertion, broad-spectrum antibiotics and analgesia. Primary repair, when feasible, is the treatment of choice. Additional procedures beyond primary repair, such as relief of concomitant obstruction, may be necessary if there is underlying esophageal pathology. Drainage alone can be performed for perforations of the cervical esophagus that cannot be visualized. Esophageal T-tube placement or exclusion and diversion techniques are appropriate in clinically unstable patients and in cases where primary repair is precluded either due to preexisting esophageal disease or extensive esophageal damage. Esophagectomy should be performed in patients with malignancy, end-stage benign esophageal disease or extensive esophageal damage that precludes repair. Endoscopic techniques, including stenting, clipping or vacuum therapy, can be used in select cases. Finally, nonoperative management should be reserved for patients with contained esophageal perforations, limited extraluminal soilage and no evidence of systemic inflammation.
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Affiliation(s)
- Savvas Lampridis
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Sofoklis Mitsos
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Martin Hayward
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK
| | - David Lawrence
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Nikolaos Panagiotopoulos
- Thoracic Surgery Department, University College London Hospitals, NHS Foundation Trust, London, UK
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10
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Nasir UM, Ahmed A, Panchal D, Choi C, Rodgers B, Kutner M, Ahlawat S. Endoscopic Retrograde Cholangiopancreatography Leading to Pharyngeal Perforation. Case Rep Gastroenterol 2020; 14:80-86. [PMID: 32231506 PMCID: PMC7098341 DOI: 10.1159/000506182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/27/2020] [Indexed: 11/19/2022] Open
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) had become the favored method to access the pancreaticobiliary system because it is a safer and less invasive method compared to surgery. However, as with any procedure, ERCP comes with its own risks and potential complications. We present a unique case of a patient who underwent ERCP and developed necrotizing infection of the neck and a submandibular abscess. The patient is a 66-year-old female who presented to an outside hospital with complaint of right upper quadrant abdominal pain, workup of which revealed choledocholithiasis. ERCP was attempted; however, cannulation was unsuccessful. The patient was discharged home after the procedure, but within 48 h she presented to our institution complaining of left-sided neck pain, dysphagia, and drooling. CT of the neck revealed extensive gas and fluid collections at the left submandibular space. The patient was taken to the operating room for drainage of the left neck abscess. Drainage and irrigation of the abscess yielded Streptococcus mitis and Hemophilus parainfluenza. The rest of patient's hospital course was uncomplicated, and she was discharged with appropriate follow-up. In the case of our patient, ERCP was complicated by a perforation of the hypopharynx. Pharyngeal perforation can be subclassified into supraglottic and infraglottic. The most frequent cause of perforations is due to increased pressure in an intrinsically weak anatomical region of the pharynx. Such perforations are commonly due to the advancement of the endotracheal tube or transthoracic echo probe, but can also be due to advancement of an endoscope.
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Affiliation(s)
- Umair M Nasir
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Ahmed Ahmed
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Dayna Panchal
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Catherine Choi
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Brandon Rodgers
- Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Matthew Kutner
- Division of Gastroenterology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Sushil Ahlawat
- Division of Gastroenterology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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11
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Siddiqi S, Schraufnagel DP, Siddiqui HU, Javorski MJ, Mace A, Elnaggar AS, Elgharably H, Vargo PR, Steffen R, Hasan SM, Raja S. Recent advancements in the minimally invasive management of esophageal perforation, leaks, and fistulae. Expert Rev Med Devices 2019; 16:197-209. [PMID: 30767693 DOI: 10.1080/17434440.2019.1582329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Historically, the gold standard management of esophageal perforations, leaks, and fistulae has been traditional open surgery, but it is associated with significant morbidity and mortality. Minimally invasive approaches offer alternatives to surgery in treating hemodynamically stable patients with such defects. In this review article, we will discuss the recent advancements in the minimally invasive management of esophageal perforations, leaks, and fistulas. AREAS COVERED This review includes information from case reports, case series, and clinical trials on minimally invasive management of esophageal perforations, leaks, and fistulas. The focus is on the devices, outcomes, and application of the technology. EXPERT COMMENTARY Minimally invasive treatment represents significant progress in the management of esophageal perforations, leaks, and fistulas. Based on current evidence, it seems safe and effective but it is evolving and more studies are needed to help draw definitive conclusions.
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Affiliation(s)
- Shirin Siddiqi
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Dean P Schraufnagel
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Hafiz Umair Siddiqui
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Michael J Javorski
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Adam Mace
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Abdulrhman S Elnaggar
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Haytham Elgharably
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Patrick R Vargo
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Robert Steffen
- b Department of Cardiovascular Surgery , Minneapolis Heart Institute Foundation , Minneapolis , MN , USA
| | - Saad M Hasan
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
| | - Siva Raja
- a Thoracic and Cardiovascular Surgery , Cleveland Clinic Foundation , Cleveland , OH , USA
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12
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Minimally invasive management of esophageal perforation. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:496-503. [PMID: 32082789 DOI: 10.5606/tgkdc.dergisi.2018.15354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/07/2017] [Indexed: 02/07/2023]
Abstract
Esophageal perforation is a medical emergency associated with high morbidity and mortality. There is no consensus on the optimal treatment of this life-threatening condition. Conventional treatment of esophageal perforation is surgical. However, more recently, endoscopic treatment has become the treatment of choice given its less invasive nature compared to surgical treatment. This includes endoscopic clip administration, endoscopic stent placement, endoscopic suturing, endoscopic vacuum therapy and tissue sealants which are all administered via the endoluminal route. Whilst small defects (<2 cm) may be closed with endoscopic clips, larger defects require stent placement or suturing. Removable esophageal stent is an effective method of treatment in cases with esophageal perforation as they allow minimal invasive repair of perforation and rapid nutrition. Endoscopic suturing can be used both to fix the stent to prevent migration and to primarily close the perforation. If perforation is associated with a mediastinal collection, drainage is mandatory and this procedure can be performed by computed tomography guided percutaneous drainage, thoracoscopy or endoscopic vacuum therapy. In some cases, a combination of these minimally invasive methods is required. Since endoscopic methods provide better quality of life and outcomes and shorten length of hospitalization, such methods have become the treatment of choice for esophageal perforation.
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13
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Ghoshal UC, Karyampudi A, Verma A, Nayak HK, Mohindra S, Morakhia N, Saraswat VA. Perforation following pneumatic dilation of achalasia cardia in a university hospital in northern India: A two-decade experience. Indian J Gastroenterol 2018; 37:347-352. [PMID: 30121890 DOI: 10.1007/s12664-018-0874-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/30/2018] [Indexed: 02/04/2023]
Abstract
Pneumatic dilation (PD) is a cost-effective first-line treatment for achalasia. The most feared complication of PD is esophageal perforation (EP). As data on EP after PD for achalasia are not widely reported, we present the frequency, risk factors, and treatment-outcome of EP. Records of patients undergoing PD for achalasia (January 1995 to September 2015) were retrospectively reviewed. Of 433 patients (age 38 years, 13-88, 57% male), and 521 dilations, 12 were complicated by EP (2.7% of patients and 2.3% of PD). EP occurred in 7 (3.4%), 4 (1.7%), and 1 (4.1%) with use of balloon diameters 30, 35, and 40 mm, respectively. In most (11/12, 92%), EP occurred during the first PD. No risk factor for EP was identified (p = 0.65 for the first dilation vs. > 1 dilation, and 0.75 for balloon size of 30 mm vs. > 30 mm). Seven patients with contrast leak on esophagogram and/or computed tomography scan underwent surgery. One other with contrast leak was successfully treated with a fully covered self-expandable metal stent (FC-SEMS); the remaining four with small leak/pneumomediastinum were managed conservatively. The median duration of hospital stay following perforation was 13 days (7-26) and 8 days (6-10) in surgery and conservative groups, respectively. No mortality was observed in either group. The frequency of EP with PD was 2.3%. Though most EP (92%) occurred during the first dilation, neither the balloon size nor repeated dilations were identified as risk factors. Both surgical and conservative approaches had a favorable outcome in appropriate settings.
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Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
| | - Arun Karyampudi
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Abhai Verma
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Hemanta K Nayak
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Samir Mohindra
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Nakul Morakhia
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Vivek A Saraswat
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
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Eroglu A, Aydin Y, Yilmaz O. Thoracic perforations-surgical techniques. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:40. [PMID: 29610732 DOI: 10.21037/atm.2017.04.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Esophageal perforation may occur spontaneously, iatrogenically or in connection with traumas. Sepsis may develop in connection with mediastinal and pleural exposure in a very short time as a consequence of disintegration of the esophagus. Esophageal perforation is an emergency accompanied with a high level of mortality and morbidity. Rate of mortality for the perforations in the thoracic region is higher than that in the cervical and abdominal regions. Delay in diagnosis and treatment is the most important factor to affect the mortality. A quick and true diagnosis of esophageal perforation is prerequisite for a successful treatment. There is no certain consensus in relation with the optimal treatment of that life-threatening condition. However, in the event that perforation is detected early in a healthy esophagus, then primary repair is recommended. When it is detected late, nonoperative conservative treatment would be appropriate. The rates of mortality for the operations following a period of 24 h after rupture formation are higher than 50%. Esophagectomy is a type of an operation that is to be considered in the event of an end stage benign esophageal disease or of a large esophageal damage that does not allow primary repair. Significant decrease has been observed in the morbidity and mortality of esophageal perforation due to the improvements in the endoscopical techniques today. Minimally invasive techniques, in which drug eluting stents come first, will become an important step for the treatment of esophageal perforations in the forthcoming years.
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Affiliation(s)
- Atilla Eroglu
- Department of Thoracic Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Yener Aydin
- Department of Thoracic Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Omer Yilmaz
- Department of Gastroenterology, Medical Faculty, Ataturk University, Erzurum, Turkey
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Herbold T, Chon SH, Grimminger P, Maus MKH, Schmidt H, Fuchs H, Brinkmann S, Bludau M, Gutschow C, Schröder W, Hölscher AH, Leers JM. Endoscopic Treatment of Transesophageal Echocardiography-Induced Esophageal Perforation. J Laparoendosc Adv Surg Tech A 2018; 28:422-428. [PMID: 29327976 DOI: 10.1089/lap.2017.0559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Perforation of the esophagus is the most severe complication of transesophageal echocardiography (TEE) and can lead to mediastinitis, pleural empyema, or peritonitis. Currently, the majority of patients receive operative treatment with only 6% treated endoscopically. We report our experience with endoscopic and conservative approaches. METHODS We retrospectively reviewed all patients treated for esophageal perforation and included all patients with perforation caused by TEE. All patients with perforation of the esophagus by TEE probe underwent conservative or endoscopic treatment, drainage of pleural and mediastinal retentions, and adjusted to antibiotic therapy. RESULTS From January 2004 to December 2014 a total of 109 patients were treated for esophageal perforation in our department. In 6 patients (5.5%) the perforation was caused by TEE. Location was cervical and midthoracic in 2 and 4 cases, respectively. All patients underwent successful endoscopic treatment and no further surgical procedure, such as esophageal suture or resection was necessary. The mean time between TEE and therapy of the perforation was 7.3 days. In all patients closure of the leakage could be achieved within 30 days. Mortality rate was 0%. CONCLUSIONS Esophageal perforations caused by TEE are typically small, in the cervical and mid esophagus, and minimally contaminated. These are good prognostic factors for successful endoscopic treatment with preservation of the esophagus. Operative treatment should only be considered in cases of failed endoscopic treatment.
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Affiliation(s)
- Till Herbold
- 1 Department of General-, Visceral- and Tumor-Surgery, University of Aachen , Aachen, Germany .,2 Department of General, Visceral Surgery, and Surgical Oncology, University of Cologne , Cologne, Germany
| | - Seung-Hun Chon
- 2 Department of General, Visceral Surgery, and Surgical Oncology, University of Cologne , Cologne, Germany
| | - Peter Grimminger
- 3 Department of General, Visceral, and Transplant Surgery, University of Mainz , Mainz, Germany
| | - Martin K H Maus
- 2 Department of General, Visceral Surgery, and Surgical Oncology, University of Cologne , Cologne, Germany
| | - Henner Schmidt
- 4 Department of Visceral and Transplant Surgery, University Hospital of Zürich , Zürich, Switzerland
| | - Hans Fuchs
- 2 Department of General, Visceral Surgery, and Surgical Oncology, University of Cologne , Cologne, Germany
| | - Sebastian Brinkmann
- 2 Department of General, Visceral Surgery, and Surgical Oncology, University of Cologne , Cologne, Germany
| | - Marc Bludau
- 2 Department of General, Visceral Surgery, and Surgical Oncology, University of Cologne , Cologne, Germany
| | - Christian Gutschow
- 4 Department of Visceral and Transplant Surgery, University Hospital of Zürich , Zürich, Switzerland
| | - Wolfgang Schröder
- 2 Department of General, Visceral Surgery, and Surgical Oncology, University of Cologne , Cologne, Germany
| | - Arnulf H Hölscher
- 2 Department of General, Visceral Surgery, and Surgical Oncology, University of Cologne , Cologne, Germany
| | - Jessica M Leers
- 2 Department of General, Visceral Surgery, and Surgical Oncology, University of Cologne , Cologne, Germany
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16
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Hershman SH, Kunkle WA, Kelly MP, Buchowski JM, Ray WZ, Bumpass DB, Gum JL, Peters CM, Singhatanadgige W, Kim JY, Smith ZA, Hsu WK, Nassr A, Currier BL, Rahman RK, Isaacs RE, Smith JS, Shaffrey C, Thompson SE, Wang JC, Lord EL, Buser Z, Arnold PM, Fehlings MG, Mroz TE, Riew KD. Esophageal Perforation Following Anterior Cervical Spine Surgery: Case Report and Review of the Literature. Global Spine J 2017; 7:28S-36S. [PMID: 28451488 PMCID: PMC5400185 DOI: 10.1177/2192568216687535] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
STUDY DESIGN Multicenter retrospective case series and review of the literature. OBJECTIVE To determine the rate of esophageal perforations following anterior cervical spine surgery. METHODS As part of an AOSpine series on rare complications, a retrospective cohort study was conducted among 21 high-volume surgical centers to identify esophageal perforations following anterior cervical spine surgery. Staff at each center abstracted data from patients' charts and created case report forms for each event identified. Case report forms were then sent to the AOSpine North America Clinical Research Network Methodological Core for data processing and analysis. RESULTS The records of 9591 patients who underwent anterior cervical spine surgery were reviewed. Two (0.02%) were found to have esophageal perforations following anterior cervical spine surgery. Both cases were detected and treated in the acute postoperative period. One patient was successfully treated with primary repair and debridement. One patient underwent multiple debridement attempts and expired. CONCLUSIONS Esophageal perforation following anterior cervical spine surgery is a relatively rare occurrence. Prompt recognition and treatment of these injuries is critical to minimizing morbidity and mortality.
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Affiliation(s)
| | - William A. Kunkle
- Broward Health Medical Center, Fort Lauderdale, FL, USA,Nova Southeastern University, Fort Lauderdale, FL, USA
| | | | | | | | - David B. Bumpass
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | - Weerasak Singhatanadgige
- Chulalongkorn University, Pathumwan, Bangkok, Thailand,King Chulalongkorn Memorial Hospital, Pathumwan, Bangkok, Thailand
| | | | - Zachary A. Smith
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Wellington K. Hsu
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Ra’Kerry K. Rahman
- Springfield Clinic, LLP, Springfield, IL, USA,Southern Illinois University, Springfield, IL, USA
| | | | | | | | - Sara E. Thompson
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Zorica Buser
- University of Southern California, Los Angeles, CA, USA
| | | | | | | | - K. Daniel Riew
- Columbia University, New York, NY, USA,New York-Presbyterian/The Allen Hospital, New York, NY, USA,K. Daniel Riew, MD, The Spine Hospital at NY-Presbyterian/Allen, 5141 Broadway, New York, NY 10034, USA.
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17
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Kansara B, Thombare C, Majhi SK, Chand RK, Malhotra R. Transesophageal Echocardiography Probe-Induced Hypopharyngeal and Esophageal Injury: A Case Report. J Cardiothorac Vasc Anesth 2017; 31:e42-e43. [PMID: 28216200 DOI: 10.1053/j.jvca.2016.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Bhuvnesh Kansara
- Departments of Cardiac Anesthesiology and Cardiothoracic Surgery Max Super Speciality Hospital Saket New Delhi, India
| | - Charusheela Thombare
- Departments of Cardiac Anesthesiology and Cardiothoracic Surgery Max Super Speciality Hospital Saket New Delhi, India
| | - Sanjay Kumar Majhi
- Departments of Cardiac Anesthesiology and Cardiothoracic Surgery Max Super Speciality Hospital Saket New Delhi, India
| | - Rajesh Kumar Chand
- Departments of Cardiac Anesthesiology and Cardiothoracic Surgery Max Super Speciality Hospital Saket New Delhi, India
| | - Rajneesh Malhotra
- Departments of Cardiac Anesthesiology and Cardiothoracic Surgery Max Super Speciality Hospital Saket New Delhi, India
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18
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Zimmermann M, Hoffmann M, Jungbluth T, Bruch HP, Keck T, Schloericke E. Predictors of Morbidity and Mortality in Esophageal Perforation: Retrospective Study of 80 Patients. Scand J Surg 2016; 106:126-132. [DOI: 10.1177/1457496916654097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Aims: Esophageal perforation is a life-threatening disease. Factors impacting morbidity and mortality include the cause and site of the perforation, the time to diagnosis, and the therapeutic procedure. This study aimed to identify risk factors for morbidity and mortality after esophageal perforation. Patients and Methods: This retrospective study analyzed data collected from all patients treated for esophageal perforation at the Department of Surgery, University of Schleswig–Holstein, Luebeck Campus, from January 1986 through December 2011. Results: Altogether, 80 patients (52 men, 28 women; mean age 65 years) were treated. The cause of perforation was intraluminal in 44 (55%) (group A) and extraluminal in 2 (3%) (group B). Spontaneous perforations were observed in 12 (15%) (group C). Perforations were due to a preexisting esophageal disease in 22 (28%) (group D). The survival rate was higher for group A (82%) than for groups B (50%), C (57%), and D (59%). The distal third of the esophagus had the highest prevalence of perforations (49, 61%) independent of the cause. Mortality, however, was independent of the perforation site. Perforations were diagnosed within 24 h in 57% (n = 46) of patients, associated with a statistically significant lower mortality rate (p = 0.035). Altogether, 40 patients underwent non-operative treatment, and among those 27 had endoscopic treatment. Emergency thoracic surgery was performed in 40 patients: direct suture of the defect (n = 26), partial esophageal resection (n = 11), other (n = 3). Significantly higher morbidity (p = 0.007) and prolonged hospitalization (p < 0.0001) was observed among patients who underwent emergency surgery. Mortality was higher in the surgical group (14/40) than in the non-operative treatment group (9/40) but without statistical significance. Conclusion: Intraluminal perforations, rapid initiation of therapy, and non-operative treatment were associated with favorable outcomes. The perforation site did not have an impact on outcomes. Esophageal resection was associated with high mortality.
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Affiliation(s)
- M. Zimmermann
- Department of Surgery, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - M. Hoffmann
- Department of Surgery, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - T. Jungbluth
- Department of Surgery, Klinikum Wolfsburg, Wolfsburg, Germany
| | - H. P. Bruch
- Department of Surgery, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - T. Keck
- Department of Surgery, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - E. Schloericke
- Department of Surgery, Westküstenklinikum Heide, Heide, Germany
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19
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Abstract
Rupture of pyriform sinus due to forced effort with closed glottis has been reported but is extremely rare. We report a case of rupture of pyriform sinus following multiple episodes of vomiting with subsequent development of pyopneumothorax.
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Affiliation(s)
- Rahul Tyagi
- Department of Pulmonary Medicine, INHS Asvini, Mumbai, Maharashtra, India
| | - Madhusudan Barthwal
- Department of Pulmonary Medicine, Military Hospital, Pune, Maharashtra, India
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20
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Chang K, Barghash M, Donnino R, Freedberg RS, Hagiwara M, Bennett G, Benenstein R, Saric M. Extrinsic Esophageal Compression by Cervical Osteophytes in Diffuse Idiopathic Skeletal Hyperostosis: A Contraindication to Transesophageal Echocardiography? Echocardiography 2015; 33:314-6. [PMID: 26603685 DOI: 10.1111/echo.13115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Contraindications to transesophageal echocardiography (TEE) include various esophageal pathologies, but compression of the esophagus by vertebral osteophytes is not listed in the current American Society of Echocardiography guidelines. We report a case of diffuse idiopathic skeletal hyperostosis (DISH) in an 81-year-old man who had incidentally been found to have extrinsic esophageal compression by cervical osteophytes prior to a proposed TEE. The incidence of esophageal perforation in patients with DISH and vertebral osteophytes is not well documented. We believe these patients are at increased risk of esophageal perforation during TEE, and thus, TEE may be relatively contraindicated in patients with DISH.
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Affiliation(s)
- Kevin Chang
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Maya Barghash
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Robert Donnino
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York.,Veterans Affairs New York Harbor Healthcare System, New York, New York.,Department of Radiology, New York University School of Medicine, New York, New York
| | - Robin S Freedberg
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Mari Hagiwara
- Department of Radiology, New York University School of Medicine, New York, New York
| | - Genevieve Bennett
- Department of Radiology, New York University School of Medicine, New York, New York
| | - Ricardo Benenstein
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
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21
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Abstract
Complete extra-esophageal migration of a foreign object is rare. Its early and accurate diagnosis by complementary imaging modalities is crucial for a successful extraction. We present a case of ingested wire bristle, which completely traversed the esophageal mucosa to position itself in the soft tissue of the left neck adjacent to the internal carotid artery. We discuss the importance of imaging in the detection of migrating foreign bodies, and raise awareness of this serious complication.
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23
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Pharyngeal perforation after blunt cervical trauma in child. Int J Pediatr Otorhinolaryngol 2014; 78:5-9. [PMID: 24290954 DOI: 10.1016/j.ijporl.2013.10.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 10/06/2013] [Indexed: 11/24/2022]
Abstract
Pharyngeal perforation caused by non-penetrating cervical trauma is an extremely rare clinical entity both in adults and children. Data concerning management of this type of injury are quite rare in surgical and even scarcer in pediatric literature. Since delay in treatment may be associated with life-threatening complications, prompt diagnosis coupled with appropriate therapy is essential for achieving favorable clinical outcome. To the best of authors' knowledge, the present study illustrates for the first time the experience with successful treatment of pharyngeal perforation caused by a blunt cervical trauma in a child.
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24
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25
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Abstract
Endoscopy has an ever-increasing role in the treatment of complications in digestive surgery. Endoscopic treatment is essentially used for (i) fistula or intra-abdominal collection secondary to anastomotic dehiscence and (ii) anastomotic stricture, especially esophagogastric, but also sometimes after colorectal surgery. First intention treatment of fistula following esophagogastric surgery is the insertion of an extractable self-expandable metallic stent (partially or entirely covered); this is supported by a low level of scientific evidence, but clinical experience has been satisfactory. Other techniques for treatment of anastomotic leak have also been reported anecdotally (clip placement, sealing with glue). There are few data available in the literature on endoscopic management (stents essentially) of postoperative colonic fistula. Whatever the approach chosen to treat a postoperative digestive tract fistula, management is medico-surgical and cannot be limited to simple closure of the digestive tube wall defect. Drainage of any collections by endoscopic, radiologic or surgical approach, systemic treatment of infection and nutritional support are essential adjuvant treatment modalities. Treatment of postoperative esophageal or colonic strictures is essentially endoscopic and is based on initial dilatation (endoscopic with hydrostatic balloon or bougie), and placement of extractable metallic stents (partially or entirely covered) in case of refractory outcome.
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Affiliation(s)
- X Dray
- Université Paris Diderot, Paris 7, AP-HP, Service d'Hépatogastroentérologie, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
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26
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Vanuytsel T, Lerut T, Coosemans W, Vanbeckevoort D, Blondeau K, Boeckxstaens G, Tack J. Conservative management of esophageal perforations during pneumatic dilation for idiopathic esophageal achalasia. Clin Gastroenterol Hepatol 2012; 10:142-9. [PMID: 22064041 DOI: 10.1016/j.cgh.2011.10.032] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Revised: 09/25/2011] [Accepted: 10/24/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Esophageal perforation is the most serious adverse event of pneumatic dilation (PD) for achalasia; it is usually managed by surgical repair. We investigated risk factors for esophageal perforation after PD and evaluated safety and long-term outcome of nonsurgical management strategies. METHODS We analyzed medical records of patients with achalasia who were treated with PD from 1992-2010 at the University Hospital Gasthuisberg in Leuven, Belgium; all patients with esophageal perforation were contacted to determine long-term outcomes. Achalasia outcomes were assessed by using the Vantrappen criteria. RESULTS Of 830 PD procedures performed on 372 patients with manometry-confirmed achalasia (57 ± 1 years, 51% male), 16 were complicated by transmural esophageal perforation (4.3% of patients, 1.9% of dilations). Age >65 years was the only significant risk factor for complications (odds ratio, 3.5; 95% confidence interval, 1.2-10.2). All patients were treated conservatively with broad-spectrum antibiotics and nothing by mouth. In 6 patients (38%) the clinical course was further complicated by a pleural effusion, which required a drain in 4 patients. One patient (6%) died of mediastinal hemorrhage within 12 hours after PD. Patients with complications were discharged after 19 ± 2.3 days, compared with 4 ± 0.2 days for those without complications (P < .0001). Long-term outcomes (mean follow-up, 84 ± 14 months) were determined for 12 patients (75%); 11 had excellent or good outcomes (69%), and 1 had a moderate outcome (6%). CONCLUSIONS Age >65 years is a significant risk factor for esophageal perforation after PD. Nonsurgical management of transmural esophageal tears is feasible, with favorable short-term and long-term outcomes, but is not devoid of complications.
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Affiliation(s)
- Tim Vanuytsel
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
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27
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Lu X, Guo Q, Ni B. Esophagus perforation complicating anterior cervical spine surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21:172-7. [PMID: 21874293 DOI: 10.1007/s00586-011-1982-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 08/02/2011] [Accepted: 08/14/2011] [Indexed: 01/17/2023]
Abstract
PURPOSE To study the diagnosis and treatment strategy of esophagus perforation complicating anterior cervical spine surgery. METHODS From 2000 to 2010, we performed 1,045 cases of anterior cervical surgeries. One developed esophagus perforation. The diagnosis and treatment strategy of this case and the other five patients with esophagus perforation from other hospitals were retrospectively reviewed. For an intraoperative perforation, primary double layer suture was performed. Postoperatively, the patient took nutrition by a nasogastric tube instead of oral intake for one week. For three cases of perforations early in the post-operative period, oral intake was forbidden and nasogastric tube was conducted for nutrition support. The wound was debrided and open drainage was conducted postoperatively. Intravenous broad-spectrum antibiotic therapy was utilized. For perforations at postoperative year 3 and 7, prohibition of oral intake, intravenous broad-spectrum antibiotics therapy, and nasogastric tube nutrition support were all conducted and surgical debridement was performed. In operation, fixation plates and screws were removed, and the edges of the perforation were loosely approximated by synthetic absorbable sutures. Postoperatively, skin wound was kept open for drainage. RESULTS All the perforations healed evenly without secondary complications. CONCLUSIONS When a perforation is suspected, imaging techniques should be employed. Surgical treatment facilitates the healing of esophagus perforation. Supportive treatments including prohibition of oral intake, intravenous broad-spectrum antibiotic therapy, feeding with a nasogastric tube were mandatory parts of treatments.
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Affiliation(s)
- Xuhua Lu
- Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, 200003, People's Republic of China.
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28
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Abstract
Boerhaave's syndrome is the spontaneous transmural rupture of the esophagus. A high degree of clinical suspicion is a prerequisite for its prompt diagnosis, and early therapeutic intervention reduces its associated morbidity and mortality. Factors that influence the outcome are location and extent of perforation and the timing of medical or surgical treatment. Boerhaave's syndrome is the most lethal perforation of the gastrointestinal tract. Delay in intervention relates directly to increased mortality. Despite advances in surgical techniques and endoscopic therapies, this disorder still has high morbidity and mortality rates. The outcome of patients with this disorder is dependent upon the prompt and accurate diagnosis. Initial stabilization of the patient with intravenous fluids and antibiotics is of key importance, with subsequent decisive therapy initiated using either a conservative medical or endoscopic or surgical approach. Boerhaave's syndrome often occurs in otherwise-relatively healthy patients. This postemetic perforation of the esophagus can result in a devastating injury that usually is exacerbated by delayed diagnosis. This article will focus on its clinical presentations and review its potentially applicable therapies.
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Affiliation(s)
- Daniel Wolfson
- Jamie S. Barkin, MD, MACG Division of Gastroenterology, Mt. Sinai Medical Center, 4300 Alton Road, Miami Beach, FL 33140, USA.
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29
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Bavalia N, Anis A, Benz M, Maldjian P, Bolanowski PJ, Saric M. Esophageal perforation, the most feared complication of TEE: early recognition by multimodality imaging. Echocardiography 2011; 28:E56-9. [PMID: 21366685 DOI: 10.1111/j.1540-8175.2010.01291.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Esophageal perforation is the most feared complication of transesophageal echocardiography (TEE), although the overall risk is extremely low. We report a case of esophageal perforation in a 77-year-old woman who had no apparent contraindications to TEE. Chronic steroid therapy for symptoms of asthma as well as osteophytic changes of the cervical vertebrae contributed to her increased risk of perforation. Unlike in prior reports, the perforation in this case was fortuitously recognized rapidly due to ingestion of a carbonated beverage for evaluation of a hiatal hernia suspected during a subsequent transthoracic echocardiogram performed because of inadequate TEE images after a difficult intubation. The incidence of esophageal perforation in our series (1 in 5,000 TEEs, 0.02%) is similar to that reported in the literature. Early recognition and prompt surgical repair of the esophageal perforation led to favorable outcome in our patient.
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Affiliation(s)
- Nisha Bavalia
- Department of Medicine Department of Radiology Department of Surgery, New Jersey Medical School, Newark, New Jersey, USA
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30
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Ghogomu NT, Kallogjeri D, Nussenbaum B, Piccirillo JF. Iatrogenic esophageal perforation in patients with head and neck cancer: evaluation of the SEER-Medicare database. Otolaryngol Head Neck Surg 2010; 142:728-34. [PMID: 20416464 DOI: 10.1016/j.otohns.2010.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 01/06/2010] [Accepted: 01/20/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE 1) Determine rate of iatrogenic esophageal perforation in head and neck cancer patients. 2) Identify risk factors for perforation. 3) Determine effect of perforation on mortality. STUDY DESIGN Secondary data analysis. SETTING Surveillance, Epidemiology, and End Results-Medicare-linked database. SUBJECTS AND METHODS Patients diagnosed with squamous cell carcinoma of the upper aerodigestive tract between January 1995 and December 2002 who underwent esophagoscopy were included. Primary outcome was the rate of iatrogenic esophageal perforation. Secondary outcomes included identification of risk factors for perforation and effect of perforation on mortality. Logistic regression analysis and the chi(2) test were used to evaluate risk factors and 30-day mortality. RESULTS There were 152 perforations in 126 patients, for a rate of 2.70 percent (95% confidence interval [CI] 2.28-3.20) per patient (n = 4659) and 1.44 percent (1.21-1.67) per esophagoscopy (n = 10,529). Odds of perforation were increased in patients with cancer of the pharynx (odds ratio [OR] 4.49, 1.82-11.08), pyriform sinus (OR 5.00, 2.10-11.93), and larynx (OR 3.39, 1.57-7.34), and those who underwent both surgery and radiation (OR 1.75, 11.12-2.74). Each esophagoscopy increased odds of perforation by 22 percent (17-28). Compared with diagnostic esophagoscopy, perforation was 2.9 times (1.77-4.69) more likely when dilatation was performed. Thirty-day postperforation mortality was 7.1 percent, a three percent absolute increase (-1.5 to 7.5) over the postesophagoscopy rate in patients without perforation. CONCLUSION Head and neck squamous cell carcinoma patients are a high-risk population for iatrogenic pharyngoesophageal perforation. Perforation is related to esophagoscopy frequency and type, tumor location, and use of multimodality therapy.
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Affiliation(s)
- Nsangou T Ghogomu
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
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31
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Mangiavillano B, Viaggi P, Masci E. Endoscopic closure of acute iatrogenic perforations during diagnostic and therapeutic endoscopy in the gastrointestinal tract using metallic clips: a literature review. J Dig Dis 2010; 11:12-8. [PMID: 20132426 DOI: 10.1111/j.1751-2980.2009.00414.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Iatrogenic perforations that occur during the endoscopic procedures are generally surgically managed, even if some authors prefer a non-surgical approach in selected cases. The endoscopic application of metallic clips has been widely used in the gastrointestinal (GI) tract for hemostasis and also for marking lesions. Since 1993 several series of endoscopic perforations treated with endoclips have been described in the literature. In this review we offer a descriptive analysis of the reported cases of the acute iatrogenic perforation, describing the closure of different perforations occurring in the GI tract, treated with metallic clips.
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Affiliation(s)
- Benedetto Mangiavillano
- Department of Gastroenterology and Gastrointestinal Endoscopy, San Paolo University Hospital, Milan, Italy.
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32
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De Caro G, Pagano N, Malesci A, Hervoso C, Danese S, Romeo F, Delconte G, Repici A. Endoclipping for gastric perforation secondary to second session of EMRC in locally residual early gastric cancer: a case report. Dig Liver Dis 2009; 41:e32-4. [PMID: 18620913 DOI: 10.1016/j.dld.2008.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 04/15/2008] [Accepted: 04/23/2008] [Indexed: 12/11/2022]
Abstract
A 72-year-old woman underwent gastric endoscopic mucosal resection with a cap-fitted endoscope for an adenocarcinoma in situ. She was scheduled for endoscopic follow-up at 1 and 3 months after the procedure. By the third month of follow up, biopsies of a slightly depressed scar area showed an high grade epithelial dysplasia. For this reason a second endoscopic resection (ER) was performed using the oblique soft cap. A perforation in the site of endoscopic resection was immediately observed. The complication was treated successfully by the application of seven clips.
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Affiliation(s)
- G De Caro
- Department of Gastroenterology and Digestive Endoscopy Unit, IRCCS, Istituto Clinico Humanitas, Rozzano, MI, Italy
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Abstract
Esophageal perforation is most commonly iatrogenic in origin with nasogastric tube insertion, stricture dilation, and endotracheal intubation, being the most frequent sources of the injury in infants and children. Clinical presentation depends on whether the cervical, thoracic, or abdominal esophagus is injured. Any patient complaining of chest pain after an upper endoscopy has esophageal perforation until proven otherwise. In infants and children, plain chest films and esophagography may assist in making the diagnosis. Hemodynamically stable patients with a contained perforation may be managed medically. Free perforation and hemodynamic lability mandates a more aggressive surgical approach for wide drainage of the mediastinum and pleural spaces. Exploration of the chest for attempted direct repair of the injury is now only rarely indicated. Mortality rates have been reported between 20 and 28% with delays in diagnosis and treatment appearing to be most strongly correlated with poor outcomes.
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Affiliation(s)
- Jeffrey W Gander
- Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons and Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY 10032, USA
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34
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Sternocleidomastoid Muscle Flap in Esophageal Perforation Repair After Cervical Spine Surgery. ACTA ACUST UNITED AC 2008; 21:597-605. [DOI: 10.1097/bsd.0b013e31815c5f96] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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36
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Abstract
The esophagus provides a diagnostic and therapeutic pathway not only for gastroenterologists but for surgeons, radiologists, cardiologists, and other specialists. Unfortunately, this procedural traffic occasionally leads to iatrogenic injury. As well, though reasonably well protected anatomically, frank esophageal injuries due to non-iatrogenic causes are not uncommon. We present a review of the literature on this subject covering anatomy, etiology, diagnostics, therapeutics, and management generally.
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Affiliation(s)
- E Plott
- San Antonio Uniformed Services Health Education Consortium, Gastroenterology, TX, USA
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37
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Abstract
Endoscopic closure of gastrointestinal perforations, fistulas, and anastomotic dehiscence is technically feasible. Endoluminal closure of the instrumental perforations of the gastrointestinal tract can be accomplished immediately after the recognition of perforation, while avoiding the delay of arranging surgery and the trauma associated with thoracotomy or laparotomy. In addition, endoscopic closure should be considered in patients with anastomotic dehiscence and chronic fistulas as this may avoid the risk associated with reoperation. The outcome of closure depends on the technical expertise in the proper selection and use of various endoluminal closure options. Training of the endoscopists in the use of this novel technology will enhance the quality of care of our patients.
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Affiliation(s)
- G S Raju
- Center for Endoscopic Research, Training, and Innovation (CERTAIN), Department of Internal Medicine, 4.106 McCullough Building, 301 University Boulevard, University of Texas Medical Branch, Galveston, TX 77555-0764, USA.
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38
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Hanafy EEDM, Ashebu SD, Naqeeb NA, Nanda HB. Pericardial sac perforation: a rare complication of neonatal nasogastric tube feeding. Pediatr Radiol 2006; 36:1096-8. [PMID: 16896693 DOI: 10.1007/s00247-006-0258-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 05/05/2006] [Accepted: 05/31/2006] [Indexed: 10/24/2022]
Abstract
The insertion of a nasogastric tube for feeding and gastric aspiration is a common practice in the care of newborns, especially if they are preterm and unwell. Esophageal perforation is a rare but serious complication of this procedure. Associated perforation of the pericardial sac is an unusual, severe, and previously unreported complication of nasogastric tube feeding in a neonate. We present an illustrative case.
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Smith D, Woolley S. Hypopharyngeal perforation following minor trauma: a case report and literature review. Emerg Med J 2006; 23:e7. [PMID: 16373792 PMCID: PMC2564152 DOI: 10.1136/emj.2003.012187] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2003] [Revised: 04/12/2004] [Accepted: 05/10/2004] [Indexed: 11/03/2022]
Abstract
Hypopharyngeal perforation is mainly reported in association with high velocity road traffic accidents, or with low velocity direct blows to the neck. We report a case of hypopharyngeal perforation following a low velocity motorcycle accident where neither of these mechanisms of injury was apparent. A 52 year old man was referred from the emergency department (ED) with a sore throat and dysphagia, following a low speed side impact accident. A gastrograffin swallow demonstrated a posterior pharyngeal wall tear. After 11 days of conservative hospital treatment, he recovered and was discharged. The presumed mechanism of injury in this case was cervical spine hyperextension without cervical compression.
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Affiliation(s)
- D Smith
- University Hospital of Wales, Cardiff, UK
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Raju GS, Thompson C, Zwischenberger JB. Emerging endoscopic options in the management of esophageal leaks (videos). Gastrointest Endosc 2005; 62:278-86. [PMID: 16046996 DOI: 10.1016/s0016-5107(05)01632-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Gottumukkala S Raju
- Division of Gasterology and Thoraic Surgery, Center for Endoscopic Research, Education, and Training (CERTAIN), University of Texas Medical Branch, Galveston, 77555, USA
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Martin M, Steele S, Mullenix P, Long W, Izenberg S. Management of Esophageal Perforation in a Sword Swallower: A Case Report and Review of the Literature. ACTA ACUST UNITED AC 2005; 59:233-5. [PMID: 16096569 DOI: 10.1097/01.ta.0000171446.09817.88] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Matthew Martin
- Department of Surgery, Madigan Army Medical Center, Fort Lewis, Washington, USA.
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42
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Hookey LC, Le Moine O, Deviére J. Successful endoscopic management of a cervical pharyngeal perforation and mediastinal abscess. Gastrointest Endosc 2005; 61:158-60. [PMID: 15672080 DOI: 10.1016/s0016-5107(04)02452-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Lawrence C Hookey
- Department of Gastroenterology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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43
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Xinopoulos D, Dimitroulopoulos D, Moschandrea I, Skordilis P, Bazinis A, Kontis M, Paraskevas I, Kouroumalis E, Paraskevas E. Natural course of inoperable esophageal cancer treated with metallic expandable stents: quality of life and cost-effectiveness analysis. J Gastroenterol Hepatol 2004; 19:1397-402. [PMID: 15610314 DOI: 10.1111/j.1440-1746.2004.03507.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM The aim of this study was to evaluate the efficacy and safety of endoscopic therapy with self-expanding metallic endoprostheses in the management of malignant esophageal obstruction or stenosis and the cost-effectiveness of the method in patients suffering from primary esophageal carcinoma. All patients with inoperable esophageal cancers treated with either laser palliation or endoprosthesis insertion were studied retrospectively. METHOD Between May 1997 and December 2002 obstruction of the esophagus was diagnosed in 78 patients (52 male, 26 female, age range 53-102 years, mean 72.3 years). The etiology of obstruction was squamous cell carcinoma (n = 42) and adenocarcinoma of the esophagus (n = 36). The site of obstruction was in the upper (n = 1), in the middle (n = 38) and in the lower esophagus (n = 39). In 16 cases the gastroesophageal junction was also involved. Four patients had broncho-esophageal fistulas. In all cases the tumor was considered non-resectable. A total of 89 Ultraflex metal stents were introduced endoscopically. In 46 patients dilation with Savary dilators prior to stent placement was required. RESULTS Stents were placed successfully in all patients. After 48 h, all patients were able to tolerate solid or semisolid food. During the follow-up period eight patients developed dysphagia due to food impaction (treated successfully endoscopically). Eleven patients presented with recurrent dysphagia 4-16 weeks after stenting due to tumor overgrowth and were treated with placement of a second stent. The median survival time was 18 weeks. There was no survival difference between squamous cell and esophageal adenocarcinoma. A cost-effective analysis was performed, comparing esophageal stenting with laser therapy. The mean survival and the cost were similar. A small difference of 156 Euro was noted (3.103 Euro and 2.947 Euro for each group of patients, respectively). A significant improvement in quality of life was noted in patients that underwent stenting (96% and 75%vs 71% and 57% for the first 2 months). CONCLUSION Placement of self-expanding metal stents is a safe and cost effective treatment modality that improve the quality of life, as compared with other palliative techniques, for patients with inoperable malignant esophageal obstructions. In cases of expansion of the mass a second stent can be used; however, the overall survival of these patients, is poor.
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Katsinelos P, Beltsis A, Paroutoglou G, Galanis I, Tsolkas P, Mimidis K, Pilpilidis I, Baltagiannis S, Kamberis E, Papaziogas B. Endoclipping for Gastric Perforation After Endoscopic Polypectomy: An Alternative Treatment to Avoid Surgery. Surg Laparosc Endosc Percutan Tech 2004; 14:279-81. [PMID: 15492658 DOI: 10.1097/00129689-200410000-00010] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 47-year-old woman underwent endoscopic polypectomy of a villous adenoma in the lesser curvature of the gastric antrum. Shortly after the procedure, she complained of severe abdominal pain. An abdominal x-ray showed air under the diaphragm, suggestive of gastric perforation. On re-endoscopy, the cavity at the site of polypectomy was closed using endoscopically applied metallic clips. She was treated with intravenous hyperalimentation, omeprazole, and antibiotics for 10 days. Ingestion of food was started 10 days after admission, and she was discharged without any complaints. She is free of symptoms on follow-up after 8 months, and endoscopy showed complete healing of the perforation. The procedure is the third described for the stomach in the English literature and emphasizes the use of endoclipping in selected cases of small and well-defined perforations.
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Shimizu Y, Kato M, Yamamoto J, Nakagawa S, Komatsu Y, Tsukagoshi H, Fujita M, Hosokawa M, Asaka M. Endoscopic clip application for closure of esophageal perforations caused by EMR. Gastrointest Endosc 2004; 60:636-9. [PMID: 15472698 DOI: 10.1016/s0016-5107(04)01960-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND With increasing use of EMR for early stage esophageal carcinoma, the number of cases of iatrogenic esophageal perforation is likely to increase. This study evaluated the results of endoscopic clip application for treatment of perforations caused by EMR in patients with esophageal carcinoma. METHODS Among 185 patients who underwent EMR for esophageal carcinoma, esophageal perforation occurred in 3 patients (1.6%). Metallic clips were immediately applied endoscopically to close the perforations. OBSERVATIONS All 3 patients were observed closely and were managed conservatively (intravenous hyperalimentation, antibiotics) after closure of the perforation. They were discharged without any further serious complication. CONCLUSIONS When esophageal perforation caused by EMR is immediately recognized, endoscopic application of metallic clips is appropriate therapy. However, patients must be carefully monitored for the development of generalized mediastinitis.
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Affiliation(s)
- Yuichi Shimizu
- Third Department of Internal Medicine, Hokkaido University School of Medicine, Sapporo, Japan
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46
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Brinster CJ, Singhal S, Lee L, Marshall MB, Kaiser LR, Kucharczuk JC. Evolving options in the management of esophageal perforation. Ann Thorac Surg 2004; 77:1475-83. [PMID: 15063302 DOI: 10.1016/j.athoracsur.2003.08.037] [Citation(s) in RCA: 460] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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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47
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Abstract
Iatrogenic perforation of the gastrointestinal tract is a medical emergency and is inevitable. An endoscopist must maintain a high index of suspicion despite minimal or atypical symptoms and negative radiologic studies, because perforation is a complication with tremendous morbidity and mortality. The endoscopist must know how to manage this complication appropriately and to seek immediate surgical consultation. There is ongoing controversy about when a patient should undergo nonoperative or surgical therapy. An evidence-based approach to manage iatrogenic perforation is not possible. The trend in the modern era is to less invasive, nonoperative therapy, given advancements in ICU care and antibiotics. Laparoscopy or laparoscopic-assisted (minilaparotomy) surgery is also being increasingly used with outcomes comparable with conventional laparotomy. Experience and advancements in accessories have enabled endoscopic repair of iatrogenic perforation in many situations [84]. The management algorithms provided synthesize the pertinent literature into reasonable guidelines to follow. Ultimately, an individualized approach must be taken to manage the patient with an iatrogenic perforation.
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Affiliation(s)
- Rajesh V Putcha
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center at Dallas, Room F.4.310, 5323 Harry Hines Boulevard, Dallas, TX 75390-8887, USA
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48
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Eichhorn KWG, Bley TA, Ridder GJ. [Undetected hypopharyngeal perforation with deep neck abscess and mediastinitis due to transesophageal echocardiography]. HNO 2003; 51:903-7. [PMID: 14605709 DOI: 10.1007/s00106-003-0809-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hypopharyngeal perforation is a rare but dangerous complication caused by diagnostic procedures. If there is any suspicion of perforation of the upper airways and/or upper digestive tract, immediate diagnostic and therapeutic procedures are indicated. Possible complications of a hypopharyngeal perforation are deep neck infection with subsequent mediastinitis and haemorrhage from major cervical vessels, both of which have high mortality rates. We present the case of a 65 year old male patient with perforation of the hypopharynx after transesophageal echocardiography which was unrecognized for more than 1 week. Clinical symptoms of hypopharyngeal perforation may initially be unspecific. Esophagography (Gastrografin administration) and computed tomography as well as esophagoscopy are needed to certify the diagnosis and to evaluate the extent of the lesion. Pathological findings as well as diagnostic and therapeutic needs are demonstrated and discussed.
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Affiliation(s)
- K W G Eichhorn
- Universitätsklinik für Hals-, Nasen- und Ohrenheilkunde und Poliklinik, Universitätsklinikum Freiburg
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Sato S, Kajiyama Y, Kuniyasu T, Machida M, Ouchi K, Sakai N, Sakamoto S, Iwanuma Y, Kamano T, Okamura S, Nagahama A, Tsurumaru M. Successfully treated case of cervical abscess and mediastinitis due to esophageal perforation after gastrointestinal endoscopy. Dis Esophagus 2003; 15:250-2. [PMID: 12445000 DOI: 10.1046/j.1442-2050.2002.00253.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Perforations of the esophagus are uncommon complications of flexible gastrointestinal endoscopy. Perforations after endoscopy are likely to occur in the cervical esophagus, where fiber insertion is difficult anatomically. The diagnosis should be made as soon as possible, because mediastinitis and sepsis frequently develop following esophageal perforations. The surgical strategies are dependent on the location of the perforations and the condition of the patients. For a successful outcome, surgery is a preferred treatment for most perforation cases, and non-operative treatment, such as antibiotics, parental nutrition, and no food intake by mouth, should be applied carefully.
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Affiliation(s)
- S Sato
- First Department of Surgery, Juntendo University School of Medicine, Ouji Hospital, Tokyo, Japan.
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50
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Jang KM, Lee KS, Lee SJ, Kim EA, Kim TS, Han D, Shim YM. The spectrum of benign esophageal lesions: imaging findings. Korean J Radiol 2003; 3:199-210. [PMID: 12271166 PMCID: PMC2713885 DOI: 10.3348/kjr.2002.3.3.199] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Benign esophageal lesions occur in various diseases. Barium studies are useful for the evaluation of mucosal surface lesions but provide little information about the extramucosal extent of disease. Computed tomography and magnetic resonance imaging, on the other hand, permit the assessment of wall thickness, mediastinal involvement, adjacent lymphadenopathy, and distant spread. In diseases such as fibrovascular polyps, duplication cysts, scleroderma, trauma, caustic esophagitis, hiatal hernia, esophageal diverticulum, achalasia, and paraesophageal varices, the findings of imaging studies are specific, obviating the need for further invasive diagnostic work-up. The advent of helical computed tomography and its volume data set allows the acquisition of multiplanar images, and magnetic resonance imaging is useful both for this and for tissue characterization. Thus, multiplanar cross-sectional imaging further extends the role of imaging modalities to the evaluation of benign esophageal lesions. Through an awareness of the multiplanar cross-sectional appearances of various benign esophageal lesions, the radiologist can play an important role in the detection, diagnosis, further diagnostic planning, and treatment of the diseases in which they occur.
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Affiliation(s)
- Kyung Mi Jang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Soon Jin Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Eun A Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Tae Sung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Daehee Han
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young Mog Shim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
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