1
|
Eremia IA, Anghel CA, Cofaru FA, Nica S. Early Presentation of Boerhaave Syndrome in the Emergency Department: A Case Report and Review of the Literature. Diagnostics (Basel) 2024; 14:1592. [PMID: 39125468 PMCID: PMC11311301 DOI: 10.3390/diagnostics14151592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/22/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
We present the case of a 46-year-old patient who arrived at the emergency department with chest pain following an episode of vomiting. The diagnosis was Boerhaave syndrome and acute mediastinitis. Due to the prompt presentation and the location of the rupture in the lower esophagus, emergency surgical intervention was performed, including esophageal suturing, mediastinal drainage, and jejunostomy for feeding. Postoperatively, the patient was transferred to the intensive care unit for advanced monitoring and support. The patient's condition improved favorably in the intensive care unit, allowing for extubation. Progress continued positively, and the patient was discharged 12 days postoperatively with a functional jejunostomy. At regular follow-ups, the patient's recovery remained favorable, and the jejunostomy was removed 30 days after the surgery. This case highlights the importance of rapid diagnosis and early surgical intervention in Boerhaave syndrome, demonstrating the successful management of a severe condition through a multidisciplinary effort.
Collapse
Affiliation(s)
- Irina-Anca Eremia
- Emergency Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.-A.E.); (S.N.)
- Emergency Department, University Emergency Hospital Bucharest, 050098 Bucharest, Romania;
| | - Cătălin-Alexandru Anghel
- Emergency Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.-A.E.); (S.N.)
| | | | - Silvia Nica
- Emergency Department, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (I.-A.E.); (S.N.)
- Emergency Department, University Emergency Hospital Bucharest, 050098 Bucharest, Romania;
| |
Collapse
|
2
|
Owen RP, Chidambaram S, Griffiths EA, Sultan J, Phillips AW, Vohra R, Preston S, Gossage J, Hanna GB, Underwood TJ, Maynard N, Markar SR. Multicenter, Prospective Cohort Study of Oesophageal Injuries and Related Clinical Outcomes (MUSOIC study). Ann Surg 2023; 278:910-917. [PMID: 37114497 DOI: 10.1097/sla.0000000000005889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To identify prognostic factors associated with 90-day mortality in patients with oesophageal perforation (OP), and characterize the specific timeline from presentation to intervention, and its relation to mortality. BACKGROUND OP is a rare gastro-intestinal surgical emergency with a high mortality rate. However, there is no updated evidence on its outcomes in the context of centralized esophago-gastric services; updated consensus guidelines; and novel non-surgical treatment strategies. METHODS A multi-center, prospective cohort study involving eight high-volume esophago-gastric centers (January 2016 to December 2020) was undertaken. The primary outcome measure was 90-day mortality. Secondary measures included length of hospital and ICU stay, and complications requiring re-intervention or re-admission. Mortality model training was performed using random forest, support-vector machines, and logistic regression with and without elastic net regularisation. Chronological analysis was performed by examining each patient's journey timepoint with reference to symptom onset. RESULTS The mortality rate for 369 patients included was 18.9%. Patients treated conservatively, endoscopically, surgically, or combined approaches had mortality rates of 24.1%, 23.7%, 8.7%, and 18.2%, respectively. The predictive variables for mortality were Charlson comorbidity index, haemoglobin count, leucocyte count, creatinine levels, cause of perforation, presence of cancer, hospital transfer, CT findings, whether a contrast swallow was performed, and intervention type. Stepwise interval model showed that time to diagnosis was the most significant contributor to mortality. CONCLUSIONS Non-surgical strategies have better outcomes and may be preferred in selected cohorts to manage perforations. Outcomes can be significantly improved through better risk-stratification based on afore-mentioned modifiable risk factors.
Collapse
Affiliation(s)
- Richard P Owen
- Department of Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Oxford, UK
- The Ludwig Institute for Cancer Research, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, UK
| | - Swathikan Chidambaram
- Department of Surgery and Cancer, Imperial College London, South Kensington Campus, London, UK
| | - Ewen A Griffiths
- Department of Surgery, Birmingham University Hospitals NHS Foundation Trust, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, UK
| | - Javed Sultan
- Department of Surgery, Salford Royal NHS Foundation Trust, Salford Royal Hospital, Stott Lane, Salford, UK
| | - Alexander W Phillips
- Northern Esophago-Gastric Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - Ravindra Vohra
- Trent Esophago-Gastric Unit, Nottingham University Hospitals Trust, Nottingham City Hospital, Hucknall Road, Nottingham, UK
| | - Shaun Preston
- Department of Surgery, Royal Surrey County Hospital, Royal Surrey NHS Foundation Trust, UK
| | - James Gossage
- Department of Surgery, Guy's and St Thomas' Hospitals NHS Foundation Trust, Westminster Bridge Road, London, UK
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College London, South Kensington Campus, London, UK
| | - Tim J Underwood
- Cancer Sciences Academic Unit, University of Southampton, University Rd, Southampton, UK
| | - Nick Maynard
- Department of Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Sheraz R Markar
- Department of Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| |
Collapse
|
3
|
Piratheepan A, Inthujan S, Sutharshan V. Successful retrosternal esophageal bypass with gastric transposition in the management of esophago-pleural fistula as a complication of Boerhaave syndrome. Int J Surg Case Rep 2023; 111:108797. [PMID: 37722308 PMCID: PMC10514066 DOI: 10.1016/j.ijscr.2023.108797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Boerhaave syndrome is a rare life-threatening condition that represents about 15 % of esophageal perforation and is associated with significant mortality. A subset of patients with effort rupture of the esophagus can present with esophago-pleural fistula. Management of esophago-pleural fistula remains a challenge due to the lack of high-quality evidence studies and the rarity of reported cases. Esophageal bypass with gastric transposition could have a role in management by using the same principles used in chronic esophago-pleural fistula in esophageal malignancy. CASE PRESENTATION We report a unique case of a 33-year-old male with effort rupture of esophagus who developed esophago-pleural fistula successfully managed with an esophageal bypass with gastric transposition after multiple attempts of CSES placement have failed. CLINICAL DISCUSSION Boerhaave syndrome is a rare clinical presentation with mortality ranging from 20 to 50 %. A case of Boerhaave syndrome present with esophageal pleural fistula is uncommon despite the anatomical proximity of these structures. For delayed presentation deployment of CSES to control the fistula was not effective as retrosternal esophageal bypass in this case study. CONCLUSIONS Esophageal bypass with gastric transposition might be an effective strategy for esophago-pleural fistula compared to CSES placement following delayed presentation of Boerhaave syndrome but further appropriately designed studies are required to make recommendations.
Collapse
Affiliation(s)
- A Piratheepan
- Department of Surgery, Teaching Hospital Jaffna, Sri Lanka.
| | - S Inthujan
- Department of Surgery, Teaching Hospital Jaffna, Sri Lanka
| | - V Sutharshan
- Department of Surgery, Teaching Hospital Jaffna, Sri Lanka
| |
Collapse
|
4
|
Delayed Esophageal Perforation Diagnosed 12 Years After Anterior Cervical Diskectomy and Fusion: A Case Report and Review of Current Literature. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202210000-00003. [PMID: 36227832 PMCID: PMC9575766 DOI: 10.5435/jaaosglobal-d-22-00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/25/2022] [Indexed: 11/05/2022]
Abstract
Esophageal perforation associated with anterior cervical diskectomy and fusion (ACDF) is a rare but serious complication. ACDF-related esophageal perforations can be acute or delayed. Delayed perforations more than 10 years after ACDF are exceedingly rare. Here, a delayed esophageal perforation discovered 12 years after a three-level ACDF is presented. This case highlights two main points. First, all diverticula after an ACDF warrant close clinical monitoring. Second, routine follow-up should be performed for patients with screw pullout to assist in early diagnosis of delayed esophageal perforation.
Collapse
|
5
|
Esophago-pleural fistula. Am J Med Sci 2022; 364:e35-e36. [PMID: 35490706 DOI: 10.1016/j.amjms.2022.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/24/2021] [Accepted: 04/22/2022] [Indexed: 11/23/2022]
|
6
|
Kim JD. Prognostic factors of esophageal perforation and rupture leading to mortality: a retrospective study. J Cardiothorac Surg 2021; 16:291. [PMID: 34627308 PMCID: PMC8502388 DOI: 10.1186/s13019-021-01680-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/29/2021] [Indexed: 12/05/2022] Open
Abstract
Background Esophageal perforation and rupture (EPR) is a serious, potentially life-threatening condition. However, no treatment methods have been established, and data concerning factors affecting mortality are limited. This report presents the prognostic factors of mortality in EPR based on experience in the management of such patients. Methods For this retrospective analysis, 79 patients diagnosed as having EPR between 2006 and 2016 and managed at Gyeongsang National University Hospital were examined. The management method was determined in accordance with the location and size of the EPR, laboratory findings, and radiological findings. Thirty-nine patients were treated with surgery; and 40, with nonsurgical management. Results The most common cause of EPR was foreign body (fish bone or meat bone), followed by vomiting, iatrogenic causes, and trauma. Thirty-nine patients underwent primary repair of EPR, of whom 4 patients died. Forty patients underwent nonsurgical management, of whom 3 patients died. The remaining patients were discharged. Mortality correlated with the size of the EPR (> 25 mm) and the segmented neutrophil count percentage (> 86.5%) in the white blood cell test and differential. Conclusions The mortality risk was increased when the EPR size and the segmented neutrophil count percentage in the white blood cell test and differential was high. Delayed diagnosis, which was considered an important predictive factor in previous investigations, was not statistically significant in this study. Trial registration: Not applicable.
Collapse
Affiliation(s)
- Jong Duk Kim
- Department of Cardiothoracic Surgery, School of Medicine, Gyeonsang National University, Gyeongsang National University Hospital, Jin-Ju, 79 Gangnam-ro, Jinju-si, Gyeongsangnam-do, 52727, Republic of Korea.
| |
Collapse
|
7
|
Koirala DP, Shrestha BM, Kansal A, Poudel D, Neupane S, Dahal GR. Perforation of gastroesophageal junction, stomach, and diaphragm following blunt abdominal trauma: A near miss: A case report. Int J Surg Case Rep 2021; 81:105786. [PMID: 33887842 PMCID: PMC8041729 DOI: 10.1016/j.ijscr.2021.105786] [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: 11/15/2020] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 11/15/2022] Open
Abstract
Perforating intra-abdominal injuries are often fatal. We report perforating intra-abdominal organ injuries with rare GEJ perforation despite blunt trauma to the abdomen. Early suspicion and laparotomy to manage all the potential injuries along with effective resuscitation and prehospital care are critical. Esophageal perforations are common with high velocity automobile accidents, crush injuries and endoscopic interventions. Most common perforations occur along the cervical esophagus followed by distal esophagus.
Introduction Blunt abdominal trauma causing Gastro-esophageal junction (GEJ), diaphragm, and gastric perforation in children is a very rare occurrence. However, the injury is serious and life-threatening with significant morbidity and mortality. Presentation of case We report an unusual case of a 14-year-old boy with an accidental fall from the tree with blunt abdomen trauma with a perforating injury to GEJ, stomach, and diaphragm. Discussion Multiple vital organs in the abdominal cavity are vulnerable to damage in blunt abdominal trauma. The rarity of perforation, diagnostic delay, and early septic occurrence sums up to higher patient morbidity and mortality. A high degree of suspicion and urgent laparotomy and surgical repair forms the cornerstone in management. Conclusion Early suspicion along with effective resuscitation and early laparotomy and surgical repair is crucial for survival and optimal outcome of the patient.
Collapse
Affiliation(s)
- Dinesh Prasad Koirala
- Pediatric Surgery Unit, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.
| | | | - Ankush Kansal
- Department of GI and General Surgery, Tribhuvan University Teaching Hospital, Institute of Kathmandu, Nepal.
| | - Diptee Poudel
- Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.
| | - Subita Neupane
- Department of General Medicine and Emergency, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal.
| | - Geha Raj Dahal
- Pediatric Surgery Unit, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal.
| |
Collapse
|
8
|
Diagnostic Utility of CT and Fluoroscopic Esophagography for Suspected Esophageal Perforation in the Emergency Department. AJR Am J Roentgenol 2020; 215:631-638. [PMID: 32515607 DOI: 10.2214/ajr.19.22166] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. We evaluated the diagnostic utility of CT in emergency department (ED) patients with suspected esophageal perforation and assessed whether subsequent fluoroscopic esophagography is necessary. MATERIALS AND METHODS. This retrospective study included consecutive adult patients presenting to an urban academic tertiary care ED from January 1, 2000, to August 31, 2017, who underwent CT and fluoroscopic esophagography within 1 calendar day (< 27 hours) of each other for suspected esophageal perforation. The use of oral or IV contrast material and the CT findings (i.e., pneumomediastinum, pleural effusion, pneumothorax, unexplained mediastinal fluid or stranding, esophageal wall air or frank esophageal wall disruption, or extraluminal oral contrast material) were documented. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Surgical or procedural intervention results or clinical follow-up results were the reference standard. RESULTS. One hundred three patients met the inclusion criteria. Sensitivity, specificity, PPV, and NPV for diagnosing esophageal perforation were 100.0%, 79.8%, 32.1%, and 100.0%, respectively, with CT and 77.8%, 98.9%, 87.5%, and 97.9% with fluoroscopic esophagography. Combining CT and fluoroscopic esophagography did not improve sensitivity, specificity, PPV, or NPV relative to using CT alone. The true-positive esophageal perforation rate was 8.7% for CT and 6.8% for fluoroscopic esophagography. When CT showed only pneumomediastinum (n = 51) or no pneumomediastinum (n = 14), the NPV of CT was 100.0%. CT with oral contrast material had a PPV of 38.5%, whereas CT without oral contrast material had a PPV of 26.7%. CONCLUSION. CT has a high NPV similar to that of fluoroscopic esophagography and has greater sensitivity than fluoroscopic esophagography for diagnosing suspected esophageal perforation. Fluoroscopic esophagrams do not provide additional information that changes clinical management beyond the information that CT provides. In ED patients with suspected esophageal perforation, CT with oral contrast material should be considered the initial imaging examination and can obviate fluoroscopic esophagography.
Collapse
|
9
|
Hardman J, Sharma N, Smith J, Nankivell P. Conservative management of oesophageal soft food bolus impaction. Cochrane Database Syst Rev 2020; 5:CD007352. [PMID: 32391954 PMCID: PMC7389440 DOI: 10.1002/14651858.cd007352.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Impaction of a soft food bolus in the oesophagus causes dysphagia and regurgitation. If the bolus does not pass spontaneously, then the patient is at risk of aspiration, dehydration, perforation, and death. Definitive management is with endoscopic intervention, recommended within 24 hours. Prior to endoscopy, many patients undergo a period of observation, awaiting spontaneous disimpaction, or may undergo enteral or parenteral treatments to attempt to dislodge the bolus. There is little consensus as to which of these conservative strategies is safe and effective to be used in this initial period, before resorting to definitive endoscopic management for persistent impaction. OBJECTIVES To evaluate the efficacy of non-endoscopic conservative treatments in the management of soft food boluses impacted within the oesophagus. SEARCH METHODS We searched the following databases, using relevant search terms: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and CINAHL. The date of the search was 18 August 2019. We screened the reference lists of relevant studies and reviews on the topic to identify any additional studies. SELECTION CRITERIA We included randomised controlled trials of the management of acute oesophageal soft food bolus impaction, in adults and children, reporting the incidence of disimpaction (confirmed radiologically or clinically by return to oral diet) without the need for endoscopic intervention. We did not include studies focusing on sharp or solid object impaction. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. MAIN RESULTS We identified 890 unique records through the electronic searches. We excluded 809 clearly irrelevant records and retrieved 81 records for further assessment. We subsequently included one randomised controlled trial that met the eligibility criteria, which was conducted in four Swedish centres and randomised 43 participants to receive either intravenous diazepam followed by glucagon, or intravenous placebos. The effect of the active substances compared with placebo on rates of disimpaction without intervention is uncertain, as the numbers from this single study were small, and the rates were similar (38% versus 32%; risk ratio 1.19, 95% confidence interval 0.51 to 2.75, P = 0.69). The certainty of the evidence using GRADE for this outcome is low. Data on adverse events were lacking. AUTHORS' CONCLUSIONS There is currently inadequate data to recommend the use of any enteral or parenteral treatments in the management of acute oesophageal soft food bolus impaction. There is also inadequate data regarding potential adverse events from the use of these treatments, or from potential delays in definitive endoscopic management. Caution should be exercised when using any conservative management strategies in these patients.
Collapse
Affiliation(s)
- John Hardman
- Head and Neck Unit, The Royal Marsden Hospital, London, UK
| | - Neil Sharma
- Department of Otolaryngology, Head and Neck Surgery, University Hospitals Birmingham, Birmingham, UK
- Institute of Cancer and Genomic Studies, University of Birmingham, Birmingham, UK
| | - Joel Smith
- Department of Otolaryngology, Head and Neck Surgery, Royal Devon and Exeter Hospital, Exeter, UK
| | - Paul Nankivell
- Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Head and Neck Studies and Education, Institute of Cancer and Genomic Studies, University of Birmingham, Birmingham, UK
| |
Collapse
|
10
|
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
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Durleshter VM, Markov PV, Pykhteev VS, Gabriel SA, Dynko VY. [Minimally invasive treatment of post-burn esophageal perforation]. Khirurgiia (Mosk) 2020:93-98. [PMID: 33301261 DOI: 10.17116/hirurgia202012193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Perforation of the esophagus is a serious and dangerous condition due to progressive development of mediastinitis and sepsis. This disease is often fatal. In the last decade, endoscopic stenting of the esophagus became more common in these patients as an alternative to traditional surgery. We report successful minimally invasive endoscopic treatment of esophageal perforation with post-burn necrosis of its wall.
Collapse
Affiliation(s)
- V M Durleshter
- Region Clinical Hospital No. 2, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - P V Markov
- Region Clinical Hospital No. 2, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - V S Pykhteev
- Region Clinical Hospital No. 2, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - S A Gabriel
- Region Clinical Hospital No. 2, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| | - V Yu Dynko
- Region Clinical Hospital No. 2, Krasnodar, Russia
- Kuban State Medical University, Krasnodar, Russia
| |
Collapse
|
13
|
Singh M, Dalal S, Dhiman B, Raman S. Delayed and atypical presentation of Boerhaave's syndrome as epigastric mass. JOURNAL OF DR. NTR UNIVERSITY OF HEALTH SCIENCES 2020. [DOI: 10.4103/jdrntruhs.jdrntruhs_55_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
14
|
Abstract
PURPOSE OF REVIEW Esophageal perforations are associated with high morbidity and mortality. As opposed to surgical repair, endoscopic closure techniques have emerged over the years as a more minimally invasive approach for management. Our goal is to discuss different modalities for closure. RECENT FINDINGS Through-the-scope clips (TTSCs), over-the-scope clips (OTSCs), and esophageal stent placement are well known options for closure. We will also discuss the more recent technique of endoscopic suturing for closure of larger defects as well as prevention of esophageal stent migration. For mediastinal collections associated with perforations, a more novel endoluminal vacuum therapy (EVT) for drainage may be an option. Overall, there are several different endoscopic options that can tailored to the specific features of an esophageal perforation. This review will discuss various techniques with which a gastroenterologist or thoracic surgeon should be familiar.
Collapse
Affiliation(s)
- Shelly Gurwara
- Section on Gastroenterology, Wake Forest Baptist Health Medical Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Steven Clayton
- Section on Gastroenterology, Wake Forest Baptist Health Medical Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| |
Collapse
|
15
|
Lam HCK, Woo JKS, van Hasselt CA. Esophageal Perforation and Neck Abscess from Ingested Foreign Bodies: Treatment and Outcomes. EAR, NOSE & THROAT JOURNAL 2019. [DOI: 10.1177/014556130308201012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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
| | - John Kong Sang Woo
- Division of Otorhinolaryngology, Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong
| | - Charles Andrew van Hasselt
- Division of Otorhinolaryngology, Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong
| |
Collapse
|
16
|
Lima CMADO, Maymone W, Fazecas TM. Boerhaave’s syndrome: the role of conventional chest X-ray. Radiol Bras 2018; 51:337-338. [PMID: 30369665 PMCID: PMC6198831 DOI: 10.1590/0100-3984.2018.0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
17
|
The Role of Operation in the Treatment of Boerhaave's Syndrome. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8483401. [PMID: 30050944 PMCID: PMC6046182 DOI: 10.1155/2018/8483401] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/13/2018] [Indexed: 01/14/2023]
Abstract
Purpose This study aims to discuss the appropriate treatment strategy for spontaneous esophageal rupture. Methods Clinical data from twenty-one cases were retrospectively analyzed. The parameters included etiology, time interval between onset and treatment, therapy methods, prognosis, and length of stay. Results The ratio of males/females was 17/4, age range was 32–82 years (mean = 43.1), and the time interval between onset and treatment was as follows: <24 h: nine cases (42.8%); 24–48 h: six cases (28.6%); and >72 h: six cases (28.6%). All patients underwent operative treatment, and the following primary healing rates were achieved: <24 h: 88.9%, 24–48 h: 66.7%, and >72 h: 0. No patients died in this study. All patients were discharged with recovery, and the average hospitalization times were 18.1 days (<24 h), 27.8 days (24–48 h), and 51.2 days (>72 h). Conclusions Surgical treatment remains an effective method for treating spontaneous esophageal rupture, and the shorter the time interval between onset and treatment, possibly the better the prognosis.
Collapse
|
18
|
Mazilescu LI, Bezinover D, Paul A, Saner FH. Unrecognized Esophageal Perforation After Liver Transplantation. J Cardiothorac Vasc Anesth 2018; 32:1407-1410. [DOI: 10.1053/j.jvca.2017.10.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Indexed: 11/11/2022]
|
19
|
Tao K, Cheng H, Hu Z, Kong M. An aorto-oesophageal fistula treated with endovascular aortic repair: the fate of untreated oesophageal lesion on endoscopic follow-up. Interact Cardiovasc Thorac Surg 2018; 25:990-992. [PMID: 29049528 DOI: 10.1093/icvts/ivx167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/25/2017] [Indexed: 12/29/2022] Open
Abstract
Oesophageal foreign body is an emergency situation. Once oesophageal perforation occurs, damage and subsequent infection involving surrounding tissue or organs may ensue. We present here a rare case of aorto-oesophageal fistula which was treated with challenges. An old lady with fishbone induced oesophageal perforation, aortic pseudoaneurysm and mediastinal haematoma was treated with great vessel stent-graft placed in aortic arch, and the fish bone was removed under endoscopy thereafter. During the early follow-up period, part of the graft stent was discovered in the oesophageal perforation with no haemorrhage. The patient is still in good condition during follow-up.
Collapse
Affiliation(s)
- Kaiyu Tao
- Department of Cardiovascular Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Haifeng Cheng
- Department of Cardiovascular Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhanglong Hu
- Department of Cardiovascular Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Mingjian Kong
- Department of Cardiovascular Surgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
20
|
Hardman J, Sharma N, Smith J, Nankivell PC. Conservative interventions for the management of impacted food bolus in the oesophagus. Hippokratia 2017. [DOI: 10.1002/14651858.cd007352.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- John Hardman
- St Mary's Hospital; Department of Otolaryngology, Head and Neck Surgery; London UK W2 1NY
| | - Neil Sharma
- Queen Elizabeth Hospital; Department of Otolaryngology, Head and Neck Surgery; Birmingham UK B15 2WB
| | - Joel Smith
- Royal Devon and Exeter Hospital; Department of Otolaryngology, Head and Neck Surgery; Exeter UK EX2 5DW
| | - Paul C Nankivell
- Queen Elizabeth Hospital; Department of Otolaryngology, Head and Neck Surgery; Birmingham UK B15 2WB
- University of Birmingham; Institute of Head and Neck Studies and Education, Institute of Cancer and Genomic Sciences; Birmingham UK
| |
Collapse
|
21
|
Naspetti R, Modesti PA. Clinical decision where evidence is lacking. Intern Emerg Med 2016; 11:901-2. [PMID: 26746414 DOI: 10.1007/s11739-015-1380-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Riccardo Naspetti
- Endoscopic Surgery, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Pietro Amedeo Modesti
- Department of Medicina Sperimentale e Clinica, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| |
Collapse
|
22
|
Abstract
Esophageal surgery comprises a variety of procedures of differing complexity to treat functional and structural disorders of the esophagus. Local disease extension, surgical repair technique, and physical status of the patient primarily dictate anesthetic management of patients with esophageal pathology. Because the esophagus is in close proximity to vital organs and structures, a specific knowledge of the anatomy is essential to realize how esophageal pathology can compromise elemental physiological functions. A com prehensive anesthetic plan requires a detailed under standing of the surgical procedure in terms of approach, the extent of the operation, and associated complica tions. Consideration of comorbid conditions is equally important, as esophageal surgery is frequently per formed in debilitated and polytraumatized patients. The following article will review clinical manifestation, surgi cal therapy, and perioperative anesthetic management of the most commonly encountered esophageal disor ders. Specifically, anesthetic considerations in gastro esophageal reflux disease, esophageal carcinoma, esophageal perforation, and a variety of other esopha geal disorders will be discussed.
Collapse
Affiliation(s)
- Frank W Dupont
- Department of Anesthesia and Crtical Care, University of Chicago, Chicago, IL
| |
Collapse
|
23
|
Shehab H, Baron TH. Enteral stents in the management of gastrointestinal leaks, perforations and fistulae. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2016. [DOI: 10.18528/gii160006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hany Shehab
- Gastrointestinal Endoscopy Unit, Kasralainy University Hospital, Cairo University, Cairo, Egypt
| | - Todd H. Baron
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
24
|
An Unusual Case of Spontaneous Esophageal Rupture after Swallowing a Boneless Chicken Nugget. Case Rep Emerg Med 2016; 2016:5971656. [PMID: 26949552 PMCID: PMC4754474 DOI: 10.1155/2016/5971656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/10/2016] [Indexed: 01/07/2023] Open
Abstract
A 25-year-old previously healthy man presented to our Emergency Department with shortness of breath and epigastric pain after swallowing a boneless chicken nugget one hour prior to presentation. Physical examination revealed epigastric rigidity and tenderness. Serology was normal except for mildly elevated bilirubin and amylase. Computed tomography (CT) scan of the chest revealed a distal esophageal rupture with accompanying pneumomediastinum and left-sided pleural effusion. Treatment was initiated with administration of intravenous fluids and broad-spectrum antibiotics. Subsequently, an esophageal stent was inserted endoscopically in addition to VATS (Video-Assisted Thoracoscopic Surgery) drainage of the left-sided pleural space. This case illustrates an unusual presentation of Boerhaave's syndrome: a rare and life-threatening form of noniatrogenic esophageal rupture most often preceded by forceful vomiting. Our case demonstrates that physicians should maintain an index of suspicion for spontaneous esophageal rupture in patients presenting with shortness of breath and epigastric pain even in the absence of preceding vomiting, cough, or seizure. Additionally, ingestion of boneless, shell-less foods may be sufficient to cause rupture in individuals without underlying esophageal pathology. CT scan of the thorax and upper abdomen should be performed in these patients to rule out this rare and life-threatening diagnosis.
Collapse
|
25
|
Liguori C, Gagliardi N, Saturnino PP, Pinto A, Romano L. Multidetector Computed Tomography of Pharyngo-Esophageal Perforations. Semin Ultrasound CT MR 2016; 37:10-5. [DOI: 10.1053/j.sult.2015.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
26
|
A rare case of duodenal ulcer perforation accompanied by Boerhaave syndrome. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 12:262-5. [PMID: 26702287 PMCID: PMC4631923 DOI: 10.5114/kitp.2015.54467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/11/2013] [Accepted: 06/24/2014] [Indexed: 11/17/2022]
Abstract
Esophageal perforation is the fastest progressing and the most life-threatening disruption of gastrointestinal tract continuity. It must be regarded as an emergency condition that requires early diagnosis as well as very aggressive and rapid implementation of treatment in order to avoid serious complications and death. Methods of treatment for spontaneous esophageal perforation continue to be a matter of controversy. However, all authors emphasize that ultimate success depends largely on the time taken to establish the diagnosis. The authors of this study describe a rare case of duodenal ulcer perforation accompanied by Boerhaave syndrome.
Collapse
|
27
|
Cross MR, Greenwald MF, Dahhan A. Esophageal Perforation and Acute Bacterial Mediastinitis: Other Causes of Chest Pain That Can Be Easily Missed. Medicine (Baltimore) 2015; 94:e1232. [PMID: 26266352 PMCID: PMC4616702 DOI: 10.1097/md.0000000000001232] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Esophageal perforation is a rare condition that is commonly missed. Male gender and alcohol use are predisposing risk factors. Most of the cases are iatrogenic or traumatic; nonetheless, spontaneous cases are not uncommon. It typically occurs after vomiting or straining as the increased intra-abdominal pressure transmits into the esophagus and results in the tear. One of the main complications is acute bacterial mediastinitis from contamination with esophageal flora. This condition can be life-threatening because it is very frequently misdiagnosed and appropriate management is often delayed.A 49-year-old man presented with worsening sudden-onset interscapular back pain that then changed to chest pain with odynophagia and was found to have fever and leukocytosis.Chest computed tomography revealed signs of mediastinitis with possible esophageal perforation. He reported symptoms started 2 days ago after lifting of heavy objects. Empiric antimicrobial was begun with conservative management and avoidance of oral intake. Barium esophagram and esophagogastroduodenoscopy revealed no signs of perforation or inflammation. His symptoms resolved and he gradually resumed oral intake. Blood cultures grew Methicillin-sensitive Staphylococcus aureus and he was discharged on appropriate antibiotics for 4 weeks. He did well on follow-up 3 months after hospitalization.The case highlights the importance of considering esophageal etiologies of chest pain.
Collapse
Affiliation(s)
- Madeline R Cross
- From the Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA (MRC, MFG, AD)
| | | | | |
Collapse
|
28
|
|
29
|
Chest Pain After Vomiting. Surgery 2015. [DOI: 10.1007/978-1-4939-1726-6_51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
30
|
Sabuncuoglu MZ, Benzin MF, Dandin O, Cakir T, Sozen I, Sabuncuoglu A, Teomete U. Rare cause of oesophagus perforation. Int J Surg Case Rep 2014; 6C:138-40. [PMID: 25541369 PMCID: PMC4334877 DOI: 10.1016/j.ijscr.2014.11.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/30/2014] [Accepted: 11/18/2014] [Indexed: 01/04/2023] Open
Abstract
Oesophagus perforation is a very serious clinical event. Mortality rates increase because inexperienced physicians cannot make a diagnosis. Although there is no consensus in literature on surgical treatment choices.
INTRODUCTION Oesophagus perforations, which are generally caused by iatrogenic injuries, are a serious clinical event. There are still high rates of mortality and morbidity and there is no gold standard of surgical treatment. PRESENTATION OF CASE The case is here presented of a 54-year old female with complaints of dysphagia after having swallowed a bone in food, who was determined with oesophagus perforation on CT examination. DISCUSSION Oesophagus perforation generally occurs secondary to interventional procedures and rarely develops associated with foreign bodies. Treatment depends on the perforation site and dimension. CONCLUSION While conservative primary surgical repair may be chosen for cervical lesions, more aggressive approaches such as resection and delayed reconstruction are recommended for thoracic lesions. Early determination and appropriate treatment are life-saving.
Collapse
Affiliation(s)
| | - Mehmet Fatih Benzin
- Yozgat Akdagmadeni State Hospital, General Surgery Department, Yozgat, Turkey
| | - Ozgur Dandin
- University of Miami Miller School of Medicine, Department of Surgery, Ryder Trauma Center, Miami, FL, USA
| | - Tugrul Cakir
- Antalya Education and Research Hospital, General Surgery Department, Antalya, Turkey
| | - Isa Sozen
- Ankara Numune Education and Research Hospital, General Surgery Department, Ankara, Turkey
| | - Aylin Sabuncuoglu
- Isparta State Hospital Anesthesia and Critical Care Unit, Isparta, Turkey
| | - Uygar Teomete
- University of Miami Miller School of Medicine, Department of Radiology, Miami, FL, USA
| |
Collapse
|
31
|
Abstract
Traumatic injury of the esophagus is extremely uncommon. The aims of this study were to use the Pennsylvania Trauma Outcome Study (PTOS) database to identify clinical factors predictive of esophageal trauma, and to report the morbidity and mortality of this injury. A cross-sectional review of patients presenting to 20 Level I trauma centers in Pennsylvania from 2004 to 2010 was performed. We compared clinical and demographic variables between patients with and without esophageal trauma both prior to and after arrival in the emergency room (ER). Primary mechanism of injury and clinical outcomes were analyzed. There were 231 694 patients and 327 (0.14%) had esophageal trauma. Patients with esophageal trauma were considerably younger than those without this injury. The risk of esophageal trauma was markedly increased in males (odds ratio [OR] = 2.62 [CI 1.98-3.47]). The risk was also increased in African Americans (OR = 4.61 [CI 3.65-5.82]). Most cases were from penetrating gunshot and stab wounds. Only 34 (10.4%) of esophageal trauma patients underwent an upper endoscopy; diagnosis was usually made by CT, surgery, or autopsy. Esophageal trauma patients were more likely to require surgery (35.8% vs. 12.5%; P < 0.001). Patients with esophageal trauma had a substantially higher mortality than those without the injury (20.5% vs. 1.4%; P < 0.005). In logistic regression modeling, traumatic injury of the esophagus (OR = 3.43 [2.50-4.71]) and male gender (OR = 1.52 [1.46-1.59]) were independently associated with mortality. For those patients with esophageal trauma, there was an association between trauma severity and mortality (OR = 1.10 [1.07-1.12]) but not for undergoing surgery within the first 24 hours of hospitalization (OR = 0.84; 0.39-1.83). Our study on traumatic injury of the esophagus is in concordance with previous studies demonstrating that this injury is rare but carries considerable morbidity (∼46%) and mortality (∼20%). The injury has a higher morbidity and mortality when the thoracic esophagus is involved compared to the cervical esophagus alone. The injury most commonly occurs in younger, Black males suffering gunshot wounds. Efforts to control gun violence in Pennsylvania are of paramount importance.
Collapse
Affiliation(s)
- Marc Makhani
- Section of Gastroenterology, Temple University School of Medicine, Philadelphia, PA
| | - Deena Midani
- Division of Internal Medicine, Temple University School of Medicine, Philadelphia, PA
| | - Amy Goldberg
- Department of Trauma Surgery, Temple University School of Medicine, Philadelphia, PA
| | - Frank K Friedenberg
- Section of Gastroenterology, Temple University School of Medicine, Philadelphia, PA
| |
Collapse
|
32
|
Cervical esophageal perforation: a 10-year clinical experience in north of iran. Indian J Otolaryngol Head Neck Surg 2014; 67:34-9. [PMID: 25621251 DOI: 10.1007/s12070-014-0737-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 06/02/2014] [Indexed: 10/25/2022] Open
Abstract
Perforations of the cervical esophagus are infrequent severe conditions associated with a high rate of morbidity and mortality if misdiagnosed. The diagnosis and management of cervical esophageal perforation remains a challenging clinical problem. We aimed to present our experience of the etiology, presentation, management and outcome of cervical esophageal perforation in a 10 years period. In this cross-sectional study, we reviewed the records of all patients with a diagnosis of cervical esophageal perforation admitted at the teaching Razi Hospital of Rasht, north of Iran, between 2001 and 2011. 26 patients (15 male) were studied with mean age of 47.6 ± 13.78 years, a range from 10 to 68 years. Only 16 (61.5 %) of patients were referred within 24 h of injury. The etiology was iatrogenic in 15 cases (57.69 %), foreign body ingestion in 7 cases (26.9 %), and penetrating traumatic injury in 4 cases (15.4 %). The common clinical manifestations of perforation were neck pain in 22 cases (84.6 %), fever in 19 cases (73.1 %), and subcutaneous emphysema in 12 cases (46.2 %). Barium and gastrografin swallow were performed in 57.7 and 23.1 % of patients, respectively and flexible esophagoscopy was used in 23.06 %. Most of patients (65.4 %) were managed by primary repair. Overall, mortality rate was 7.7 %. Our study demonstrates that the most common cause of cervical esophageal perforation is iatrogenic injury. Clinical suspicion is most important problem. Furthermore, Diagnosis is mainly made by Barium and gastrografin swallow. For a successful outcome, primary repair is a preferred treatment for most perforation patients.
Collapse
|
33
|
Tsukiyama A, Tagami T, Kim S, Yokota H. Use of 3-Dimensional Computed Tomography to Detect a Barium-Masked Fish Bone Causing Esophageal Perforation. J NIPPON MED SCH 2014; 81:384-7. [DOI: 10.1272/jnms.81.384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Atsushi Tsukiyama
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
| | - Shiei Kim
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
| |
Collapse
|
34
|
|
35
|
|
36
|
Bitar ZI, Ibrahim M, el-Emam HS, Bitar MZ. Normal chest X-ray should not mislead. BMJ Case Rep 2013; 2013:bcr-2013-201688. [PMID: 24306430 DOI: 10.1136/bcr-2013-201688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A lung ultrasound (US) can be routinely performed at the bedside by a trained intensive care unit physician and may provide accurate information about a lung's status that has diagnostic and therapeutic relevance. Oesophageal perforations are rare, and due to the rarity of this type of perforation and its non-specific presentation, the diagnosis and treatment are delayed, leading to a high mortality rate. We present a 70-year-old woman with a postoesophagoscopy perforated oesophagus. Lung US detected pneumothorax and mild pleural effusion that were not present on the postoperative chest X-ray. The early detection of the perforation led to a good outcome.
Collapse
|
37
|
An JS, Baek IH, Chun SY, Kim KO. Successful endoscopic band ligation of esophageal perforation by fish bone ingestion. J Laparoendosc Adv Surg Tech A 2013; 23:459-62. [PMID: 23560657 DOI: 10.1089/lap.2013.0082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Acute esophageal perforations by foreign body ingestion result in complications such as mediastinitis and retropharyngeal or parapharyngeal abscesses. Because the mortality of esophageal perforation is up to 22%, immediate treatment is critical. Herein, we report a case of successful endoscopic band ligation of esophageal perforation. A 68-year-old man was admitted complaining of substernal pain and dysphagia after ingesting a fish bone. Immediately emergency endoscopy was performed, and the fish bone was observed lodged in the lower esophagus. Although the fish bone was easily removed by an endoscopic rat-tooth forceps, esophageal perforation was found after the procedure. Endoscopic band ligation for perforation was performed. Initial chest computed tomography (CT) showed pneumomediastinum and local inflammation, but follow-up CT showed improved pneumomediastinum. The patient was given oral nutrition 2 weeks after procedure, and he was discharged without any complications. This case report emphasizes for the first time the availability of immediate endoscopic band ligation for acute esophageal perforation.
Collapse
Affiliation(s)
- Jung Sun An
- Department of Internal Medicine, Division of Gastroenterology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | | | | | | |
Collapse
|
38
|
Sahn SA, Huggins JT, San Jose E, Alvarez-Dobano JM, Valdes L. The Art of Pleural Fluid Analysis. ACTA ACUST UNITED AC 2013. [DOI: 10.1097/cpm.0b013e318285ba37] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
39
|
Patel MS, Malinoski DJ, Zhou L, Neal ML, Hoyt DB. Penetrating oesophageal injury: a contemporary analysis of the National Trauma Data Bank. Injury 2013; 44:48-55. [PMID: 22209382 DOI: 10.1016/j.injury.2011.11.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 10/29/2011] [Accepted: 11/17/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND Oesophageal trauma is uncommon. The aim of this study was to conduct a descriptive analysis of penetrating oesophageal trauma and determine risk factors for oesophageal related complications and mortality in the National Trauma Data Bank (NTDB). METHODS Patients with penetrating oesophageal trauma from Levels 1 and 2 trauma centres in the NTDB (2007 and 2008) that specified how complication and comorbidity data were recorded were selected. Data collected included age, injury severity score (ISS), abbreviated injury scores (AIS), lengths of stay (LOS) and ventilation days, systolic blood pressure (SBP) in the emergency department (ED), comorbidities, oesophageal related procedures, and oesophageal related complications. Univariate and multivariable analyses were conducted to identify significant predictors of oesophageal-related complications and mortality in patients with LOS>24 h. RESULTS 227 patients from 107 centres were studied. The mean number of patients per centre was 2 (range 1-15). Overall mortality was found to be 44% with 92% of these deaths in less than 24 h. In patients with LOS>24 h, 62% had primary repair, 13% drainage, 4% resection, 1% diversion, and 20% unspecified. No significant difference in mortality was found in patients with oesophageal related complications. The time to first oesophageal related procedure was not significantly different in those with oesophageal related complications or those who died. Significant predictors of oesophageal related complications were age and AIS of the abdomen or pelvic contents ≥3 and the only significant predictor of mortality was ISS. CONCLUSIONS Most deaths in penetrating oesophageal trauma occur in the first 24 h due to severe associated injuries. Primary repair was the most common intervention, followed by drainage and resection. Oesophageal related complications were not found to significantly increase mortality and time to first oesophageal related procedure did not affect outcomes in this subset of patients from the NTDB.
Collapse
|
40
|
Byaruhanga R, Kakande E, Mwambu T. A rare case of a patient with a foreign body in the esophagus for two years which perforated into the mediastinum. Afr Health Sci 2012; 12:569-71. [PMID: 23513078 DOI: 10.4314/ahs.v12i4.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 6-year-old girl was referred to the ENT (Ear nose and throat) unit at Mulago National Referral Hospital with a foreign body in the esophagus diagnosed by routine chest radiograph. The child's parents recall she had ingested a round object (galvanised iron umbrella cap of a roofing nail) two years prior to this, but they thought that the child had passed it out in stool since she had continued eating and swallowing normally. On arrival at the National referral hospital, the child had two esophagoscopies done but the foreign body was not seen, not until a barium swallow was done was it confirmed that the FB(foreign body) had perforated the esophagus and entered the mediastinum. The cardiothoracic surgeons were consulted, and they removed the foreign body via a thoracotomy. The child recovered well and was discharged from hospital on day 55.
Collapse
Affiliation(s)
- R Byaruhanga
- Department of Otolaryngology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
| | | | | |
Collapse
|
41
|
Delappe RS, Vattoth S, Sonavane SK. Esophageal entrapment with blunt thoracic spinal trauma. Emerg Radiol 2012; 20:243-6. [PMID: 23070256 DOI: 10.1007/s10140-012-1085-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 10/08/2012] [Indexed: 11/28/2022]
Abstract
Esophageal injury due to blunt trauma rarely occurs. However, prompt diagnosis and treatment of such injury is essential to improve patient survival. We report an extremely rare case of esophageal entrapment within a hyperextension fracture dislocation of the thoracic spine, which was diagnosed by reviewing an esophagram and CT image simultaneously. Esophageal injury should be considered with thoracic spine trauma, especially if the T3/4 level is involved.
Collapse
Affiliation(s)
- R Steven Delappe
- Department of Radiology, University of Alabama at Birmingham, 619 19th St South, Birmingham, AL 35249-6830, USA.
| | | | | |
Collapse
|
42
|
[Esophageal injury following blunt thoracic trauma. A case report and review of the literature]. Unfallchirurg 2012; 115:1123-5. [PMID: 23052701 DOI: 10.1007/s00113-012-2256-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this article was to raise the awareness of the difficulties physicians face in the diagnosis and treatment of esophageal perforation following blunt thoracic trauma. We present a case of esophagus perforation following blunt chest trauma in the course of a motorcycle accident. Within 24 h the patient was admitted to the University hospital, and presented with progressive pain, subfebrile temperature, leukocytosis and pneumomediastinum. Emergency surgery revealed extensive esophageal lesions. A two-stage surgical approach was chosen with initial resection and temporary closure of the esophagus. After 2 months the integrity of the esophagus could be restored without complications.
Collapse
|
43
|
Jabłoński S, Brocki M, Kordiak J, Misiak P, Terlecki A, Kozakiewicz M. Acute mediastinitis: evaluation of clinical risk factors for death in surgically treated patients. ANZ J Surg 2012; 83:657-63. [DOI: 10.1111/j.1445-2197.2012.06252.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Sławomir Jabłoński
- Department of Thoracic Surgery, General and Oncological Surgery; Medical University of Lodz; Łódź; Poland
| | - Marian Brocki
- Department of Thoracic Surgery, General and Oncological Surgery; Medical University of Lodz; Łódź; Poland
| | - Jacek Kordiak
- Department of Thoracic Surgery, General and Oncological Surgery; Medical University of Lodz; Łódź; Poland
| | - Piotr Misiak
- Department of Thoracic Surgery, General and Oncological Surgery; Medical University of Lodz; Łódź; Poland
| | - Artur Terlecki
- Department of Thoracic Surgery, General and Oncological Surgery; Medical University of Lodz; Łódź; Poland
| | - Marcin Kozakiewicz
- Department of Faciomaxillary Surgery; Medical University of Lodz; Łódź; Poland
| |
Collapse
|
44
|
Van Waes OJ, Cheriex KCAL, Navsaria PH, van Riet PA, Nicol AJ, Vermeulen J. Management of penetrating neck injuries. Br J Surg 2012; 99 Suppl 1:149-54. [PMID: 22441870 DOI: 10.1002/bjs.7733] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Routine surgical exploration after penetrating neck injury (PNI) leads to a large number of negative neck explorations and potential iatrogenic injury. Selective non-operative management (SNOM) of PNI is gaining favour. The present study assessed the feasibility of SNOM in PNI. METHODS Seventy-seven consecutive patients with PNI presenting to a tertiary trauma centre were included in this prospective study from September 2009 to December 2009. All patients were managed according to Advanced Trauma Life Support guidelines, and either underwent emergency surgery or were managed without surgery, based on clinical presentation and/or outcome of special investigations. RESULTS Eight patients (10 per cent) were haemodynamically unstable at presentation. Foley catheter balloon tamponade (FCBT) was successful in stopping active bleeding in six of these patients, and diagnostic angiography revealed an arterial injury in five. The remaining 69 patients were managed using SNOM. Angiography or computed tomography was done in 41 patients (53 per cent), and showed arterial injury in 15. These injuries were treated surgically (7 patients), radiologically (stenting in 3) or conservatively. Contrast swallow and/or endoscopy were performed in 37 patients (48 per cent) for suspected oesophageal injury, but yielded no positive results. During follow-up no missed injuries were detected. CONCLUSION FCBT was useful in patients with PNI and active bleeding. Stable patients should undergo additional investigation based on clinical findings only.
Collapse
Affiliation(s)
- O J Van Waes
- Departments of Trauma Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
45
|
Ando H, Shitara Y, Hagiwara K, Hara K, Mogami Y, Kobayashi T, Yajima T, Tani M, Morinaga N, Ishizaki M, Kuwano H. Successful surgical treatment of a spontaneous rupture of the esophagus diagnosed two days after onset. Case Rep Gastroenterol 2012; 6:260-5. [PMID: 22679415 PMCID: PMC3369410 DOI: 10.1159/000338653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Esophageal perforation is a relatively uncommon disease with a high rate of mortality and morbidity. Delay in the diagnosis and treatment occurs in more than 50% of cases, leading to a mortality rate of 40–60%. Primary repair is generally considered the gold standard for patients who present within the first 24 h following perforation of the esophagus. In this paper, we present a case of successful surgical treatment of spontaneous rupture of the esophagus that was diagnosed 2 days after onset. The patient was a 42-year-old man admitted to internal medicine with a diagnosis of pleuritis and complaining of chest and back pain. The next day, computed tomography revealed left-sided pleural effusion and mediastinal emphysema. An esophagogram revealed extravasation of the contrast medium from the lower left esophagus to the mediastinal cavity. These results confirmed a rupture of the esophagus, and an emergency left thoracotomy was performed. The perforation was repaired with a single-layered closure and was covered with elevated great omentum obtained by laparotomy. The patient was discharged 23 days after the first surgery. In conclusion, primary repair surgery must be selected as the best treatment beyond 24 h if the patient's general state was stable and there was no evidence of clinical sepsis.
Collapse
Affiliation(s)
- Hiroyuki Ando
- Department of Surgery, Fujioka General Hospital, Fujioka, Gunma University, Maebashi, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Katabathina VS, Restrepo CS, Martinez-Jimenez S, Riascos RF. Nonvascular, nontraumatic mediastinal emergencies in adults: a comprehensive review of imaging findings. Radiographics 2012; 31:1141-60. [PMID: 21768244 DOI: 10.1148/rg.314105177] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Given their high frequency, mediastinal emergencies are often perceived as being a result of external trauma or vascular conditions. However, there is a group of nonvascular, nontraumatic mediastinal emergencies that are less common in clinical practice, are less recognized, and that represent an important source of morbidity and mortality in patients. Nonvascular, nontraumatic mediastinal emergencies have several causes and result from different pathophysiologic mechanisms including infection, internal trauma, malignancy, and postoperative complications, and some may be idiopathic. Some conditions that lead to nonvascular, nontraumatic mediastinal emergencies include acute mediastinitis; esophageal emergencies such as intramural hematoma of the esophagus, Boerhaave syndrome, and acquired esophagorespiratory fistulas; spontaneous mediastinal hematoma; tension pneumomediastinum; and tension pneumopericardium. Although clinical findings of nonvascular, nontraumatic mediastinal emergencies may be nonspecific, imaging findings are often definitive. Awareness of various nonvascular, nontraumatic mediastinal emergencies and their clinical manifestations and imaging findings is crucial for making an accurate and timely diagnosis to facilitate appropriate patient management.
Collapse
Affiliation(s)
- Venkata S Katabathina
- Department of Radiology, University of Texas Health Science Center, San Antonio, TX 78229, USA.
| | | | | | | |
Collapse
|
47
|
Yoon SY, Shim KN, Kim HI, Kwon KJ, Song EM, Kim SE, Jung HK, Jung SA. Mediastinitis due to Esophageal Perforation as a Complication of Diagnostic Esophagogastroduodenoscopy. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2012. [DOI: 10.7704/kjhugr.2012.12.4.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- So Yoon Yoon
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ki-Nam Shim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hye In Kim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyoung-Joo Kwon
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Eun-Mi Song
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Seong-Eun Kim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hye-Kyung Jung
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung-Ae Jung
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| |
Collapse
|
48
|
Addas R, Berjaud J, Renaud C, Berthoumieu P, Dahan M, Brouchet L. Esophageal Perforation Management: A Single-Center Experience. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojts.2012.24023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
49
|
Abstract
In this article, we reviewed our experience of treatment of cervical esophageal perforation caused by foreign bodies. Between 1980 and 2010, 42 patients were included in this study. There were 18 women and 24 men with a median age of 54 years. We divided the patients into three groups: the patients whose foreign bodies could not be extracted by otolaryngologists using endoscope (n= 7), the patients who had some signs of abscess formation but the foreign bodies had been extracted using endoscope (n= 25), and the patients who had no signs of abscess formation and the foreign bodies had been extracted (n= 10). We treated the patients of the three groups with surgical treatment, drainage alone, and conservative treatment, respectively. The outcome of the current series was favorable. Our experience suggested that most of the cases can be treated conservatively or by drainage alone. If the foreign bodies of the esophagus could not be extracted using endoscope, surgical treatment including the removal of the foreign bodies, primary repair, and drainage should be performed.
Collapse
Affiliation(s)
- J Jiang
- Department of Thoracic Surgery, Beijing Tongren Hospital Department of Thoracic Surgery, Beijing Chest Hospital, Beijing, China
| | | | | | | | | |
Collapse
|
50
|
Lee DH, Kim NH, Hwang CJ, Lee CS, Kim YT, Shin MJ, Cho SK. Neglected esophageal perforation after upper thoracic vertebral fracture. Spine J 2011; 11:1146-51. [PMID: 22208858 DOI: 10.1016/j.spinee.2011.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 09/22/2011] [Accepted: 11/15/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Esophageal perforation associated with thoracic fracture is extremely rare. If not diagnosed at an early stage, it can lead to life-threatening complications, such as mediastinitis and sepsis. PURPOSE To report a case of esophageal perforation after T2 compression fracture that was initially missed and subsequently developed into osteomyelitis involving adjacent vertebrae. STUDY DESIGN A case report and review of the literature. METHODS A 49-year-old man with severe upper thoracic back pain and intermittent fever was referred to our hospital. Five months before presentation, the patient was diagnosed with compression fracture of T2 vertebra with a teardrop fragment. On initial computed tomography (CT) and magnetic resonance imaging (MRI), there was no appreciable periesophageal-free gas. However, the posterior wall of the esophagus was compressed by a beak-like fracture fragment. Magnetic resonance imaging showed an infectious spondylitis of T1-T2, which mimicked esophageal cancer with local tumor infiltration. No dye leakage from the esophagus was found on contrast esophagography. RESULTS After empiric antibiotic therapy for 4 months, subsequent radiographs of the spine did not reveal any further collapse or destruction of the vertebral bodies, and inflammatory markers returned to normal limits. There was no recurrence of symptoms at the 2-year follow-up. CONCLUSIONS Esophageal perforation after upper thoracic vertebral fracture can develop when the fracture fragment pierces the posterior wall of the esophagus. In addition to periesophageal-free air, crushing, distortion, or marked displacement of the esophagus at the cervicothoracic junction on CT or MRI is a clue to potential esophageal injury. If not identified early, patients may present with chronic osteomyelitis extending to adjacent vertebrae.
Collapse
Affiliation(s)
- Dong-Ho Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap 2-dong, Songpa-gu, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|