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Eguchi S, Hisaeda Y, Ukawa T, Koto M, Hosokawa M, Tsurisawa C, Takeda T, Amagata S, Nakao A. Clinical Features of iatrogenic Pharyngo-esophageal perforation in very low birth weight infants. Pediatr Neonatol 2024:S1875-9572(24)00072-X. [PMID: 38769031 DOI: 10.1016/j.pedneo.2023.11.011] [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: 10/05/2023] [Revised: 11/10/2023] [Accepted: 11/27/2023] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Iatrogenic pharyngoesophageal perforation (IPEP) is one of the complications of gastric tube insertion and it tends to occur more frequently in premature infants. Although the frequency is significantly low, attention should be paid as it can lead to serious outcomes with high mortality. This study will help raise awareness with respect to early diagnosis, management, and prevention. METHODS We performed a retrospective cohort study of all very low birth weight infants diagnosed with IPEP between 1993 and 2022. RESULTS A total of 6 patients (0.27% of very low birth weight infants) with the diagnosis of IPEP were included. The median gestational age was 27 + 1 weeks (range 23+5-28 + 6 weeks), and the median birth weight was 823 g (range 630-1232 g). Symptoms included difficulty with gastric tube insertion, bloody secretions in the oral cavity, and increased oral secretions. X-rays revealed aberrant running of the gastric tube in all patients. In three cases, contrast studies demonstrated contrasted mediastinum tapering like a bead. Laryngoscope was used to view the perforation sites but this was not useful in the smallest patient. All patients were treated conservatively with antibiotics and survived. CONCLUSIONS When inserting a gastric tube for premature infants, it is critical to remember that these infants are at risk of IPEP. In addition to a frontal X-ray, a lateral X-ray and contrast study may be useful for early diagnosis.
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Affiliation(s)
- Shu Eguchi
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
| | - Yoshiya Hisaeda
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Toshiko Ukawa
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Mayu Koto
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Miku Hosokawa
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Chisa Tsurisawa
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Tomohiro Takeda
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Shusuke Amagata
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Atsushi Nakao
- Department of Neonatology, Japanese Red Cross Medical Center, Tokyo, Japan, 4-1-22, Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
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2
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The outcome of esophageal perforation in neonates and its risk factors: a 10-year study. Pediatr Surg Int 2023; 39:127. [PMID: 36792814 DOI: 10.1007/s00383-023-05417-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] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Esophageal perforation is a rare complication in infants that can be difficult to diagnose. The mortality rate due to esophageal perforation is high. This condition is more common in low birth weight premature infants. This study examines esophageal perforation in relation to various demographic and clinical variables. METHODS This study has a cross-sectional design. All pre-term neonates with esophageal perforation at Valiasr Hospital in Tehran, Iran, were included in the study over the span of ten years, from 2011 to 2021. Factors, such as gestational age, sex, weight, type of delivery, and interventions performed that could contribute to the condition, including intubation and Orogastric (OG) tube insertion, were investigated in the participants. RESULTS Among the 9924 infants studied over the 10-year period, 15 cases (0.15%) had esophageal perforation. All these infants underwent non-operative management with acceptable results. CONCLUSION Learning about the risk factors for iatrogenic esophageal perforation in neonates can help prevent this unwanted event in most cases. Also, the majority of these cases can be managed non-operatively provided that early diagnosis is made.
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3
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Lalani I, Shaman Z, Kourouni I. A Hydropneumothorax That Was! Chest 2022; 161:e387-e390. [DOI: 10.1016/j.chest.2021.05.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/25/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022] Open
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4
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Chan Y, Cheuk KY, Lai KW, Mak KL, Lai TW. Esophageal perforation following cervical spinal surgery with instrumentation: A case report on primary repair with pedicled sternocleidomastoid muscle flap reinforcement and review of the literature. SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Y. Chan
- Department of Surgery Princess Margaret Hospital Hong Kong
| | - K. Y. Cheuk
- Department of Surgery Princess Margaret Hospital Hong Kong
| | - K. W. Lai
- Department of Surgery Princess Margaret Hospital Hong Kong
| | - K. L. Mak
- Department of Surgery Princess Margaret Hospital Hong Kong
| | - T. W. Lai
- Department of Surgery Princess Margaret Hospital Hong Kong
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5
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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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6
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Kourouni I, Parekh K, Mathew JP. A Hydropneumothorax That Never Was! Chest 2021; 160:e305-e309. [PMID: 34488973 DOI: 10.1016/j.chest.2020.08.2142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/06/2020] [Accepted: 08/06/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ismini Kourouni
- Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Hospital Center, Case Western Reserve University, Cleveland, OH.
| | - Karishma Parekh
- Pulmonary Critical Care, Centennial Medical Group, Inc, Mercy Medical Center, Roseburg, OR
| | - Joseph P Mathew
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Morningside and Mount Sinai West Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY
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7
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Hashmi MAR, El-Badawy M, Agha A. Suspecting a fatal condition on a plain chest radiograph; Boerhaave syndrome. Scott Med J 2020; 66:46-48. [PMID: 32981463 DOI: 10.1177/0036933020961181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Spontaneous oesophagus rupture, also known as Boerhaave syndrome, is a rare but near-fatal medical condition and despite recent medical advancements, it remains a diagnostic challenge for front-door clinicians. The authors describe a similar presentation in an elderly gentleman who presented to the emergency department with sudden chest pain post vomiting. His initial chest radiograph showed bilateral dense consolidations and pleural effusions, and was treated as sepsis secondary to bilateral pneumonia. He underwent computed tomography pulmonary angiogram to rule out pulmonary embolism because of his chest pain with elevated D-dimer which confirmed the diagnosis of oesophagus rupture. His care was transferred to Surgical and Intensive care colleagues with plans for radiological chest drain insertion to limit contamination of mediastinum, however the patient became hypoxic and hypotensive and despite maximal organ support passed away within 6 hours of admission. Retrospect review of chest radiograph revealed Peri-oesophageal air tracking, a sign of Boerhaave syndrome. The aim of this case is to emphasise the importance of raising the suspicion of Boerhaave syndrome in patients with sudden chest pain, unexplained pleural effusion or pneumothorax with a history of recent vomiting as early diagnosis holds the key to prompt lifesaving management.
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Affiliation(s)
| | | | - Adnan Agha
- Consultant Acute Medicine/Diabetes & Endocrinology, University Hospitals of Derby and Burton, UK
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8
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Dormagen JB, Verma N, Fink KR. Imaging in Oncologic Emergencies. Semin Roentgenol 2020; 55:95-114. [PMID: 32438984 DOI: 10.1053/j.ro.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Nupur Verma
- Department of Radiology, University of Florida, Gainesville, FL
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9
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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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10
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Sharp 3-Ended Metallic Foreign Body in an Infant Hypopharynx. Indian J Otolaryngol Head Neck Surg 2019; 71:14-17. [DOI: 10.1007/s12070-015-0908-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/16/2015] [Indexed: 10/23/2022] Open
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11
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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.
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12
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Grau Pérez M, Aguilar Mulet JM, Santiago Poveda C. Left hydropneumothorax in a patient with acute epigastric pain: an important clue! Intern Emerg Med 2018; 13:133-134. [PMID: 28779445 DOI: 10.1007/s11739-017-1727-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/29/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Mercè Grau Pérez
- Emergency Department, Hospital Universitario de La Princesa, Madrid, Spain.
- Dermatology Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.
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13
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Abstract
Traumatic esophageal injuries occur less than 10% of the time in the setting of blunt or penetrating trauma. The purpose of this literature review is to provide an update on the most recent changes involving the diagnosis and treatment of esophageal injuries. A literature search was conducted using PubMed, to identify articles written in English language with the terms "non- iatrogenic", "esophageal", "trauma", "diagnosis", "management", and "prognosis". Case reports and articles involving non-traumatic esophageal perforations were excluded. Fifty pertinent articles in English language from 1947 to 2015 were selected for review. Based on the review of all articles, we designed a diagnostic and therapeutic algorithm to facilitate the diagnosis and management of the traumatic esophageal injury.
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14
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Abstract
OPINION STATEMENT Esophageal leaks (EL) and ruptures (ER) are rare conditions associated with a high risk of mortality and morbidity. Historically, EL and ER have been surgically treated, but current treatment options also include conservative management and endoscopy. Over the last decades, interventional endoscopy has evolved as an effective and less invasive alternative to primary surgery in these cases. A variety of techniques are currently available to re-establish the continuity of the digestive tract, prevent or treat infection related to the leak/rupture, prevent further contamination, drain potential collections, and provide nutritional support. Endoscopic options include clips, both through the scope (TTS) and over the scope (OTS), stent placement, vacuum therapy, tissue adhesive, and endoscopic suturing techniques. Theoretically, all of these can be used alone or with a multimodality approach. Endoscopic therapy should be combined with medical therapy but also with percutaneous drainage of collections, where present. There is robust evidence suggesting that this change of therapeutic paradigm in the form of endoscopic therapy is associated with improved outcome, better quality of life, and shortened length of hospital stay. Moreover, recent European guidelines on endoscopic management of iatrogenic perforation have strengthened and to some degree regulated and redefined the role of endoscopy in the management of conditions where there is a breach in the continuity of the GI wall. Certainly, due to the complexity of these conditions and the variety of available treatment options, a multidisciplinary approach is strongly recommended, with close clinical monitoring (by endoscopists, surgeons, and intensive care physicians) and special attention to signs of sepsis, which can lead to the need for urgent surgical management. This review article will critically discuss the literature regarding endoscopic modalities for esophageal leak and perforation management and attempt to place them in perspective for the physician.
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15
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Abstract
Esophageal perforation (EP) is a rare complication that is often iatrogenic in origin. In contrast with adult patients in whom surgical closure of the defect is preferred, nonoperative treatment has become a common therapeutic approach for EP in neonates and children. Principles of management pediatric EP includes rapid diagnosis, appropriate hemodynamic monitoring and support, antibiotic therapy, total parenteral nutrition, control of extraluminal contamination, and restoration of luminal integrity either through time or operative approaches.
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Affiliation(s)
- Rebecca M Rentea
- Deparment of Surgery, Children׳s Mercy Hospital, 2401 Gillham Rd, Kansas City, Missouri 64108
| | - Shawn D St Peter
- Deparment of Surgery, Children׳s Mercy Hospital, 2401 Gillham Rd, Kansas City, Missouri 64108.
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16
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Maurya VK, Sharma P, Ravikumar R, Bhatia M. Boerhaave's syndrome. Med J Armed Forces India 2017; 72:S105-S107. [PMID: 28050085 DOI: 10.1016/j.mjafi.2015.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/10/2015] [Indexed: 12/18/2022] Open
Affiliation(s)
- Vinay K Maurya
- Associate Professor, Department of Radiodiagnosis, Armed Forces Medical College, Pune 411040, India
| | - Pankaj Sharma
- Associate Professor, Department of Radiodiagnosis, Armed Forces Medical College, Pune 411040, India
| | - R Ravikumar
- Professor and HOD, Department of Radiodiagnosis, Armed Forces Medical College, Pune 411040, India
| | - Mukul Bhatia
- Associate Professor, Department of Radiodiagnosis, Armed Forces Medical College, Pune 411040, India
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17
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Cayci HM, Erdoğdu UE, Dilektasli E, Turkoglu MA, Firat D, Cantay H. An unusual approach for the treatment of oesophageal perforation: Laparoscopic-endoscopic cooperative surgery. J Minim Access Surg 2017; 13:69-72. [PMID: 27251836 PMCID: PMC5206845 DOI: 10.4103/0972-9941.181760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Boerhaave syndrome describes a transmural oesophageal rupture that develops following a spontaneous, sudden intraluminal pressure increase (i.e. vomiting, cough). It has a high rate of mortality and morbidity because of its proximity to the mediastinum and pleura. Perforation localisation and treatment initiation time affect the morbidity and mortality. In this article, we aim to present our successful laparoscopic-endoscopic cooperative surgery in a 59-year-old female who was referred to our clinic with a diagnosis of spontaneous lower oesophageal perforation. Laparoscopy and a simultaneous oesophageal stent application may be assumed as an effective alternative to conventional surgical approaches in cases of spontaneous lower oesophageal perforation.
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Affiliation(s)
- Haci Murat Cayci
- Department of General Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Umut Eren Erdoğdu
- Department of General Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Evren Dilektasli
- Department of General Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Mehmet Akif Turkoglu
- Department of General Surgery, Antalya University Medical School, Antalya, Turkey
| | - Deniz Firat
- Department of General Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Hasan Cantay
- Department of General Surgery, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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18
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Esophageal Rupture After Ghost Pepper Ingestion. J Emerg Med 2016; 51:e141-e143. [DOI: 10.1016/j.jemermed.2016.05.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/06/2016] [Accepted: 05/05/2016] [Indexed: 11/18/2022]
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19
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Pezzetta E, Kokudo T, Uldry E, Yamaguchi T, Kudo H, Ris HB, Christodoulou M, Vuilleumier H, Halkic N. The surgical management of spontaneous esophageal perforation (Boerhaave's syndrome) ‒ 20 years of experience. Biosci Trends 2016; 10:120-4. [PMID: 27052150 DOI: 10.5582/bst.2016.01009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Spontaneous esophageal perforation (Boerhaave's syndrome) is an uncommon and challenging condition with significant morbidity and mortality. Surgical treatment is indicated in the large majority of cases and different procedures have been described in this respect. We present the results of a mono-institutional evaluation of the management of spontaneous esophageal perforation over a 20-year period. The charts of 25 patients with spontaneous esophageal perforation treated at the Surgical Department of the University Hospital of Lausanne were retrospectively studied. In the 25 patients, 24 patients were surgically treated and one was managed with conservative treatment. Primary buttressed esophageal repair was performed in 23 cases. Nine postoperative complications were recorded, and the overall mortality was 32%. Despite prompt treatment postoperative morbidity and mortality are still relevant. Early diagnosis and definitive surgical management are the keys for successful outcome in the management of spontaneous esophageal perforation. Primary suture with buttressing should be considered as the procedure of choice. Conservative approach may be applied in very selected cases.
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20
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Chan WY, Cheong HW, Tan TJ. Clinics in diagnostic imaging (165). Oesophageal rupture secondary to malposition of an SB tube gastric balloon. Singapore Med J 2016; 57:92-5; quiz 96. [PMID: 26891671 DOI: 10.11622/smedj.2016033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Oesophageal rupture is a life-threatening complication of balloon tamponade for bleeding oesophageal varices. We herein describe the clinical course and imaging findings in a 33-year-old Indian man who had a Sengstaken-Blakemore (SB) tube inserted for uncontrolled haematemesis, which was unfortunately complicated by malposition of the gastric balloon with resultant oesophageal rupture. The inflated SB tube gastric balloon was visualised within the right hemithorax on chest radiography after the SB tube insertion. Further evaluation of the thorax on computed tomography confirmed the diagnosis of oesophageal rupture associated with right-sided haemopneumothorax. It is crucial for both the referring clinician and reporting radiologist to recognise early the imaging features of an incorrectly positioned SB tube gastric balloon, so as to ensure prompt intervention and a reduction in patient morbidity and mortality.
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Affiliation(s)
- Wan Ying Chan
- Department of Diagnostic Radiology, Changi General Hospital, Singapore
| | - Hsueh Wen Cheong
- Department of Diagnostic Radiology, Changi General Hospital, Singapore
| | - Tien Jin Tan
- Department of Diagnostic Radiology, Changi General Hospital, Singapore
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21
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Qian SJ, Ye XS, Chen WS, Li WL. Missed diagnosis of oesophageal perforation in ankylosing spondylitis cervical fracture: Two case reports and literature review. J Int Med Res 2016; 44:170-5. [PMID: 26740499 PMCID: PMC5536578 DOI: 10.1177/0300060515614230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/30/2015] [Indexed: 12/02/2022] Open
Abstract
Oesophageal perforation after blunt injury cervical fracture in patients with ankylosing spondylitis (AS) is rarely reported. The early diagnosis of oesophageal perforation is extremely important. We present two cases of patients with AS who sustained cervical fracture dislocation and spinal cord injury. The ossified sharp fragments caused oesophageal perforation, and the delayed diagnoses had serious consequences. Oesophageal perforation should be suspected in patients with AS and cervical fracture if bone fragments are pressing against the oesophagus and a gas shadow is visible around the fracture site on computed tomography imaging.
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Affiliation(s)
- Sheng-Jun Qian
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xue-Shi Ye
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei-Shan Chen
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wan-Li Li
- Department of Orthopaedic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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22
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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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Hesketh AJ, Behr CA, Soffer SZ, Hong AR, Glick RD. Neonatal esophageal perforation: nonoperative management. J Surg Res 2015; 198:1-6. [PMID: 26055213 DOI: 10.1016/j.jss.2015.05.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/07/2015] [Accepted: 05/12/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Esophageal perforation is a rare complication of enteric instrumentation in neonates. Enteric tube placement in micro-preemies poses a particular hazard to the narrow lumen and thin wall of the developing esophagus. The complication may be difficult to recognize or misdiagnosed as esophageal atresia, and is associated with considerable mortality. Historically, management of this life-threatening iatrogenic disease was operative, but trends have shifted toward nonoperative treatment. Here, we review neonatal esophageal perforation at our own institution for management techniques, risk factors, and outcomes. MATERIALS AND METHODS Seven neonatal patients with esophageal perforation were identified and charts reviewed for demographics, comorbidities, etiology of perforation, diagnostic modalities, management decisions, complications, and outcomes. RESULTS Mean gestational age was 27.2 ± 4.0 wk, and weight at diagnosis was 892 ± 674 g. All seven patients had esophageal perforation resulting from endotracheal or enterogastric intubation and were managed nonoperatively. Treatment included removal of the offending tube, nil per os, and antibiotics. Five patients required additional interventions: four tube thoracostomies for pneumothoraces and one peritoneal drain for pneumoperitoneum. Three patients died because of sequelae of prematurity (intraventricular hemorrhage, necrotizing enterocolitis, and sepsis). One patient was diagnosed as having esophageal atresia; esophagoscopy before surgical repair established the correct diagnosis. CONCLUSIONS Neonates, particularly those under 1500 g, are at substantial risk for iatrogenic esophageal perforation during enterogastric intubation. Nonoperative management may be a safe initial strategy in the neonatal setting, but more aggressive interventions may ultimately be required. Despite recent improvement in early recognition of this injury, misdiagnosis still occurs.
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Affiliation(s)
- Anthony J Hesketh
- Division of Pediatric Surgery, Department of Surgery, Hofstra North Shore - LIJ School of Medicine, New Hyde Park, New York.
| | - Christopher A Behr
- Division of Pediatric Surgery, Department of Surgery, Hofstra North Shore - LIJ School of Medicine, New Hyde Park, New York
| | - Samuel Z Soffer
- Division of Pediatric Surgery, Department of Surgery, Hofstra North Shore - LIJ School of Medicine, New Hyde Park, New York
| | - Andrew R Hong
- Division of Pediatric Surgery, Department of Surgery, Hofstra North Shore - LIJ School of Medicine, New Hyde Park, New York
| | - Richard D Glick
- Division of Pediatric Surgery, Department of Surgery, Hofstra North Shore - LIJ School of Medicine, New Hyde Park, New York
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24
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Delayed presentation of pharyngeal erosion after anterior cervical discectomy and fusion. Case Rep Orthop 2015; 2015:173687. [PMID: 25699193 PMCID: PMC4325201 DOI: 10.1155/2015/173687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/14/2015] [Indexed: 11/26/2022] Open
Abstract
Dysphagia after anterior cervical discectomy and fusion (ACDF) is common, with a prevalence ranging between 28% and 57% of cases. However, nearly all cases resolve spontaneously within 2 years, thus identifying patients who require more detailed or invasive work-up is a challenging task for clinicians. A review of literature reveals a paucity of case reports detailing work-up and successful management options. The authors performed a clinical and radiographic review of a case of a 47-year-old female who presented with persistent dysphagia 3 years following anterior cervical spine surgery and was found to have an erosive pharyngeal defect with exposed spinal hardware. The diagnosis was made with direct laryngoscopy and treatment consisted of plate removal and pharyngeal repair, followed by revision fusion with deformity correction. This case and the accompanying pertinent review of the literature highlight the importance of a thorough evaluation of dysphagia, especially in the mid- and late-term postoperative period following ACDF, when most cases of dysphagia should have been resolved. Correctly identifying the underlying etiology of dysphagia may lead to improved revision of ACDF outcomes. Unresolved dysphagia should be a red flag for surgeons as it may be the presentation of erosive esophageal/pharyngeal damage, a rare but serious complication following ACDF.
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Donatelli J, Gupta A, Santhosh R, Hazelton TR, Nallamshetty L, Macias A, Rojas CA. To breathe or not to breathe: a review of artificial airway placement and related complications. Emerg Radiol 2014; 22:171-9. [PMID: 25266155 DOI: 10.1007/s10140-014-1271-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 09/10/2014] [Indexed: 11/29/2022]
Abstract
Artificial airway devices are commonly used to provide adequate ventilation and/or oxygenation in multiple clinical settings, both emergent and nonemergent. These frequently used devices include laryngeal mask airway, esophageal-tracheal combitube, endotracheal tube, and tracheostomy tube and are associated with various acute and late complications. Clinically, this may vary from mild discomfort to a potentially life-threatening situation. Radiologically, these devices and their acute and late complications have characteristic imaging findings which can be detected primarily on radiographs and computed tomography. We review appropriate positioning of these artificial airway devices and illustrate associated complications including inadequate positioning of the endotracheal tube, pulmonary aspiration, tracheal laceration or perforation, paranasal sinusitis, vocal cord paralysis, post-intubation tracheal stenosis, cuff overinflation with vascular compression, and others. Radiologists must recognize and understand the potential complications of intubation to promptly guide management and avoid long-term or even deadly consequences.
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Affiliation(s)
- John Donatelli
- Department of Radiology, University of South Florida College of Medicine, 2 Tampa Circle Dr. STC 7035, Tampa, FL, 33606, USA,
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Abstract
OBJECTIVE The purpose of this article is to familiarize radiologists with the specific characteristics of foreign bodies, obtained from image interpretation, to guide further management. Details of object morphologic characteristics and location in the body gained through imaging form the backbone of the classification used in the treatment of ingested foreign bodies. CONCLUSION The characteristics of foreign bodies and predisposing bowel abnormalities affect the decision to follow ingested objects radiographically, perform additional imaging, or proceed with endoscopic or surgical removal.
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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.
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Bautista A, Heine M, van Berkel V, Kelly-Frasher L, Remmel K, Akca O. Right-Sided Pleural Effusion in a Critically Ill Stroke Patient. J Investig Med High Impact Case Rep 2014; 2:2324709614523258. [PMID: 26425594 PMCID: PMC4528863 DOI: 10.1177/2324709614523258] [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] [Indexed: 11/16/2022] Open
Abstract
Pleural fluid collections are common in those critically ill. We report the case of a left middle cerebral artery stroke patient who developed respiratory distress and required intubation and mechanical ventilation. Although the patient's clinical status and oxygenation improved, there was persistence of right-sided opacity in the chest radiograph. Further workup proved a right-sided pleural effusion, which was drained and managed. Following extubation, a swallow study was ordered, which led to a fluoroscopic examination that demonstrated esophageal perforation. Thoracic surgery was consulted and did a primary repair of perforation and noted non-small cell carcinoma on the perforated site.
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Affiliation(s)
| | | | | | | | | | - Ozan Akca
- University of Louisville, Louisville, KY, USA
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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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Esophageal perforation related to anterior cervical spinal surgery. J Clin Neurosci 2013; 20:1402-5. [PMID: 23891121 DOI: 10.1016/j.jocn.2012.11.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 11/07/2012] [Accepted: 11/17/2012] [Indexed: 02/07/2023]
Abstract
Esophageal perforation is an uncommon but potentially fatal complication of anterior cervical spinal surgery. This study aimed to investigate the diagnosis and treatment of cervical esophageal perforation related to spinal surgery. Among 1097 consecutive cases of anterior cervical spinal surgery that were managed at our institution over a 20 year period, five patients with esophageal perforation were identified. We performed a retrospective review of the diagnoses and treatment of esophageal perforation in these five patients as well as another patient who was transferred from another hospital. The esophageal perforations in all six patients were recognized during the early postoperative period. All patients presented with neck pain, dysphagia, odynophagia, coughing, fever and incision swelling and drainage. Diagnosis was confirmed by one or several of the following methods: contrast swallow study; endoscopy; cervical radiographs; or oral methylene blue. Nasogastric tube, intravenous antibiotics, enteral and parenteral nutrition, and open drainage were conducted in all patients. The wound was debrided in three patients, while two had implant removal and primary suture of the perforation. Five patients had a good recovery with healing of the esophagus, while one patient died due to severe pneumonia. The early diagnosis of esophageal perforation related to cervical spinal surgery relies on clinical suspicion and efficient investigation. The selection of appropriate treatment options, which include esophageal rest, antibiotic administration, nutrition support, wound debridement, open drainage, and surgical repair, largely depends on when the perforation is recognized. Early diagnosis and prompt management of this complication are likely to result in a good clinical outcome.
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Bellaiche S, Di Blasio R, Luauté J, Jacquin-Courtois S, Boisson D, Charvier K, Tell L, Rode G. Clinical signs and radiographic evidence of esophageal perforation after tetraplegia. Ann Phys Rehabil Med 2013; 56:41-50. [PMID: 23375486 DOI: 10.1016/j.rehab.2013.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 01/11/2013] [Indexed: 11/17/2022]
Abstract
A diagnosis of esophageal perforation at some time after cervical spine surgery is difficult to establish since there exists no clinical picture specific to tetraplegic patients. We carried out a detailed retrospective study of revelatory clinical manifestations and conventional radiographic data in a series of 16 patients hospitalized at Hôpital Henry-Gabrielle (Lyon, France) for rehabilitation purposes between 1983 and 2010 and who presented this complication. The most frequent clinical picture associates cervical pain, fever and dysphagia. Simple front and side X-rays of the cervical spine led in 77% of the cases to a diagnosis of esophageal perforation. The most prevalent radiographic signs of the latter consist in osteosynthesis hardware or instrumentation failure, prevertebral free air next to the cervical esophagus and enlarged prevertebral space. Visualized esophageal X-rays, also known as series, highlight parenchymal opacity next to the posterior wall of the esophagus. A diagnosis of esophageal perforation needs to be carried out in order to facilitate suitable treatment and avoid the compromising of vital functions.
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Affiliation(s)
- S Bellaiche
- Service de médecine physique et réadaptation neurologique, hôpital Henry-Gabrielle, hospices civils de Lyon, 20, route de Vourles, 69230 Saint-Genis-Laval, France.
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Haemothorax and thoracic spine fractures in the elderly. Case Rep Radiol 2012; 2012:162064. [PMID: 22973528 PMCID: PMC3437616 DOI: 10.1155/2012/162064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 07/12/2012] [Indexed: 11/17/2022] Open
Abstract
Both osteoporotic fractures and pleural effusions are frequently observed in medicine. However, rarely does one associate a hemorrhagic pleural effusion with a thoracic spinal fracture when the patient has not sustained massive trauma. In this paper, we discuss two cases where seemingly insignificant low-energy trauma precipitated massive haemothoraces in elderly patients with underlying osteoporosis, ultimately resulting in their immediate causes of death. This paper serves to remind health care professionals of the importance of using caution when moving elderly patients as well as to consider thoracic spinal fracture as a potential explanation for a hemorrhagic pleural effusion of undetermined etiology.
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Abstract
Boerhaave syndrome is a rarely occurring condition with a high mortality rate if not diagnosed in a timely manner. Patients with this condition complain primarily of chest pain, and practitioners should consider esophageal rupture as a differential diagnosis during the initial diagnostic evaluation. Most treatment modalities have been derived from case studies, as there are no published reports on randomized controlled trials specifically dedicated to the treatment of Boerhaave syndrome. This case presentation includes the pathophysiology of esophageal rupture and the management pathways that have been shown to be successful based on current literature.
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Successful repair of esophageal perforation after anterior cervical fusion for cervical spine fracture. J Clin Neurosci 2011; 18:1374-80. [DOI: 10.1016/j.jocn.2011.02.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 02/07/2011] [Accepted: 02/13/2011] [Indexed: 11/20/2022]
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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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Kaman L, Iqbal J, Kundil B, Kochhar R. Management of Esophageal Perforation in Adults. Gastroenterology Res 2010; 3:235-244. [PMID: 27942303 PMCID: PMC5139851 DOI: 10.4021/gr263w] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2010] [Indexed: 12/16/2022] Open
Abstract
Perforation of esophagus in the adult is a very morbid condition with high morbidity and mortality. The ideal treatment is controversial. The main causes for esophageal perforation in adults are iatrogenic, traumatic, spontaneous and foreign bodies. The morbidity and mortality rate is directly related to the delay in diagnosis and initiation of optimum treatment. The reported mortality from treated esophageal perforation is 10% to 25%, when therapy is initiated within 24 hours of perforation, but it could rise up to 40% to 60% when the treatment is delayed beyond 48 hours. Primary closure of the perforation site and wide drainage of the mediastinum is recommended if perforation is detected in less than 24 hours. Treatment option for delayed or missed rupture of esophagus is not very clear and is controversial. Recently a substantial number of patients with esophageal perforation are being managed by nonoperative measures. Patients with small perforations and minimal extraesophageal involvement may be better managed by nonoperative treatment Major prognostic factors determining mortality are the etiology and site of the injury, the presence of underlying esophageal pathology, the delay in diagnosis and the method of treatment. For optimum outcome for management of esophageal perforations in adults a multidisciplinary approach is needed.
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Affiliation(s)
- Lileswar Kaman
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Javid Iqbal
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Byju Kundil
- Department of GI Surgery, Lakeshore Hospital, Cochin, Kerala, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Stent for nonmalignant leaks, perforations, and ruptures. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2010. [DOI: 10.1016/j.tgie.2011.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Chirica M, Champault A, Dray X, Sulpice L, Munoz-Bongrand N, Sarfati E, Cattan P. Esophageal perforations. J Visc Surg 2010; 147:e117-28. [PMID: 20833121 DOI: 10.1016/j.jviscsurg.2010.08.003] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The incidence of esophageal perforation (EP) has risen with the increasing use of endoscopic procedures, which are currently the most frequent causes of EP. Despite decades of clinical experience, innovations in surgical technique and advances in intensive care management, EP still represents a diagnostic and therapeutic challenge. EP is a devastating event and mortality hovers close to 20%. Ambiguous presentations leading to misdiagnosis and delayed treatment and the difficulties in management are responsible for the high morbidity and mortality rates. A high variety of treatment options are available ranging from observational medical therapy to radical esophagectomy. The potential role of interventional endoscopy and the use of stents for the treatment of EP seem interesting but remain to be evaluated. Surgical primary repair, with or without reinforcement, is the preferred approach in patients with EP. Prognosis is mainly determined by the cause, the location of the injury and the delay between perforation and initiation of therapy.
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Affiliation(s)
- M Chirica
- Service de chirurgie générale, digestive et endocrinienne, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
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Esophageal perforation in children: a review of one institution's experience. J Surg Res 2010; 164:13-7. [PMID: 20850782 DOI: 10.1016/j.jss.2010.05.049] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 04/21/2010] [Accepted: 05/20/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND The current approach to esophageal perforation treatment in children has shifted towards conservative management. However, the consensus of what constitutes conservative management is unclear, with various therapies and protocols described, including the need for various decompression and drainage procedures. Our institution utilizes conservative management with minimal intervention guided by the patient's clinical course. The purpose of this study is to report our management and add to the growing evidence for conservative management of esophageal perforation in children. METHODS We performed a retrospective chart review of all patients with an ICD-9 diagnosis of esophageal perforation from January 1995 to July 2009. Patients with postoperative anastomotic leaks with drains in place were excluded, although patients with anastomotic leaks that were not controlled by drains were included. Data collected included patient demographics, etiology, diagnosis, treatment, complications, and outcome. RESULTS Eight patients were identified who met inclusion criteria. Mean age was 28 mo (1 d-10 y), and the average time from causative event to diagnosis was 1.4 d (0-2 d). The etiology for esophageal perforation included esophagoscopy with dilation (n = 4), button battery ingestion (n = 1), coin ingestion (n = 1), nasogastric tube placement (n = 1), and leak after stricture resection (n = 1). All the patients were treated conservatively without primary surgery or thoracic drainage, and the mean time to perforation healing was 10.2 d (1-24 d). The average length of antibiotic therapy was 10 d (0-26 d). Enteral nutrition was utilized in five patients, and total parenteral nutrition (TPN) was utilized in five patients. No patient developed a new-onset esophageal stricture. CONCLUSION Conservative management, guided by the patient's clinical course, with antibiotics and nutritional support is a safe and effective treatment for esophageal perforations in children.
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Baron RD, Pal D, Crimmins DW, Dexter SPL. Spinal Epidural Abscess Presenting with Paraplegia Following Delayed Presentation of Traumatic Esophageal Perforation without Spinal Fracture: Lessons to be Learnt. Eur J Trauma Emerg Surg 2010; 36:247-9. [PMID: 26815868 DOI: 10.1007/s00068-009-8225-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Accepted: 04/26/2009] [Indexed: 10/20/2022]
Abstract
We describe a case of esophageal perforation following blunt chest trauma with delayed presentation as paraplegia secondary to spinal epidural abscess formation. The case highlights the importance of the awareness of the possibility of esophageal injury in patients following road traffic collisions.
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Affiliation(s)
- Ryan D Baron
- Department of Upper Gastrointestinal Surgery, St. JamesUniversity Hospital, West Yorkshire, UK. .,Department of Upper Gastrointestinal Surgery, St. James University Hospital, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK.
| | - Debasish Pal
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | | | - Simon P L Dexter
- Department of Upper Gastrointestinal Surgery, St. JamesUniversity Hospital, West Yorkshire, UK
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Onat S, Ulku R, Cigdem KM, Avci A, Ozcelik C. Factors affecting the outcome of surgically treated non-iatrogenic traumatic cervical esophageal perforation: 28 years experience at a single center. J Cardiothorac Surg 2010; 5:46. [PMID: 20509978 PMCID: PMC2907573 DOI: 10.1186/1749-8090-5-46] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 05/31/2010] [Indexed: 12/17/2022] Open
Abstract
Background We reviewed our experience with non-iatrogenic traumatic cervical esophageal perforations, paying particular attention to factors affecting the outcome of such cases. Methods In total, 30 patients treated surgically between 1980 and 2008 for non-iatrogenic traumatic cervical esophageal perforation in our clinic were reviewed. Results There were 25 male and 5 female patients with a median age of 27.5 years. The type of injury was external trauma in 21 (70%) patients and endoluminal injury in the remaining 9 (30%) patients. The mechanism of injury was gunshot in 16 patients, stabbing in 4, falling in 1 (extraluminal injury), and foreign body in 9 (endoluminal injuries). The overall mortality rate was 16.6% (5/30). The mortality rate for extraluminal injuries was 19%, and for endoluminal injuries was 11.1%. Mortality in patients treated within 24 h of sustaining injury was substantially less than in those for whom diagnosis and treatment were delayed (12.5 and 21.4%, respectively). The mortality rate was 33.3% (3/9) for patients with tracheal injuries and 9.5% (2/21) for those without tracheal injuries. Conclusions A treatment delay greater than 24 h, the presence of tracheal injury, or extraluminal perforation significantly affected the outcome of surgically treated non iatrogenic traumatic cervical esophageal perforation.
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Affiliation(s)
- Serdar Onat
- Department of Thoracic Surgery, Faculty of Medicine Dicle University, Diyarbakir, Turkey.
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Perforation after rigid pharyngo-oesophagoscopy: when do symptoms and signs develop? The Journal of Laryngology & Otology 2009; 124:171-4. [PMID: 19840428 DOI: 10.1017/s0022215109991629] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Perforation after pharyngo-oesophagoscopy is a serious complication, and its identification, through close patient monitoring, is essential. Yet little is known about when symptoms and signs develop, and thus how long any close monitoring should last. AIM To examine the timing of individual symptoms and signs of perforation after rigid pharyngo-oesophagoscopy. METHODOLOGY Three-centre, retrospective study. RESULTS Of 3459 patients undergoing rigid pharyngo-oesophagoscopy, 10 (0.29 per cent) developed perforations, nine of which were suspected intra-operatively. Symptoms and signs developed at 1.5 hours post-operatively at the earliest, and at 36 hours at the latest. Three patients were asymptomatic. The majority of procedures (n = 8) were undertaken for food bolus obstruction or foreign body ingestion. CONCLUSION Pharyngo-oesophagoscopy for food bolus obstruction and foreign body ingestion accounts for a large number of perforations, but symptoms and signs may take longer than 24 hours to develop. A contrast swallow should be considered in high risk patients, and a high index of suspicion maintained in order to detect this complication.
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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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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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Wang Y, Zhang R, Zhou Y, Li X, Cheng Q, Wang Y, Liu K, Wang X. Our experience on management of Boerhaave's syndrome with late presentation. Dis Esophagus 2008; 22:62-7. [PMID: 18847455 DOI: 10.1111/j.1442-2050.2008.00858.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A retrospective review of 18 patients treated for Boerhaave's syndrome in our center from 1954 to 2006 was undertaken. The patients were divided into two groups: group 1, the time delayed before treatment was less than 24 hours; group 2, the time delayed was more than 24 hours. The time interval between perforation and the onset of treatment in group 2 was from 50 hours to 30 days. Roentgenograms of the chest and esophagogram with a water-soluble contrast medium are able to reveal the perforation in most cases, and thoracentesis or thoracic drainage after swallow methylene blue may provide help as well. Surgical intervention was adopted in all three patients in group 1 and 12 in group 2, and conservative intervention in three in group 2. In group 1, two patients recovered uneventfully, the other one developed a postoperative respiratory infection, and he recovered after the infection was controlled. The mortality in group 2 was 33.3% (5/15), and the mortality in patients with conservative intervention was 100% (3/3). Five complications occurred after surgical intervention in group 2, including four fistulae and one incision infection. In conclusion, it may be appropriate to manage patients aggressively with primary repair and adequate mediastinal and pleural drainage when patients present late. Because of the syndrome's initial severity and a tendency to postoperative complications, patients should be closely monitored, and correct antibiotic therapy and adequate nutrition are very important in treatment.
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Affiliation(s)
- Y Wang
- Department of Thoracic Surgery, Tangdu Hospital, Forth Military Medical University, Xi'an, China.
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Griffin SM, Lamb PJ, Shenfine J, Richardson DL, Karat D, Hayes N. Spontaneous rupture of the oesophagus. Br J Surg 2008; 95:1115-20. [PMID: 18655213 DOI: 10.1002/bjs.6294] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the diagnosis, management and outcome of patients with spontaneous rupture of the oesophagus in a single centre. METHODS Between October 1993 and May 2007, 51 consecutive patients with spontaneous oesophageal rupture were evaluated with contrast radiology and flexible endoscopy. Patients with limited contamination who fulfilled specific criteria were managed by a non-operative approach, whereas the remainder underwent thoracotomy. RESULTS The median time to diagnosis was 24 (range 4-604) h. Initial diagnosis was by contrast swallow in 18 of 24 patients, computed tomography in 15 of 17 and endoscopy in 18 of 18. There were no deaths among 17 patients who were managed non-operatively with targeted drainage, intravenous antimicrobials, nasogastric decompression and enteral nutrition. Of 31 patients who underwent primary thoracotomy and oesophageal repair (over a Ttube in 29), 11 died in hospital. Three patients could not be resuscitated adequately and did not have surgical intervention. CONCLUSION Spontaneous oesophageal rupture represents a spectrum of disease. Accurate radiological and endoscopic evaluation can identify those suitable for radical non-operative treatment and those who require thoracotomy.
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Affiliation(s)
- S M Griffin
- Department of Upper Gastrointestinal Surgery, Northern Oesophago-gastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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Abstract
The anatomy of the esophagus is unique in that it traverses the neck, chest, and abdomen. As a result, surgeons need to be familiar with the anatomy of all three of these areas to be facile and comfortable in performing esophageal surgery. Traumatic injuries to the esophagus encompass a heterogeneous group of injuries that can be iatrogenic, external, or from physiologic forces. Primary repair of traumatic injuries is preferred when possible; however, if systemic sepsis is present and esophageal resection becomes necessary due to extensive injury or inflammation, immediate reconstruction should be delayed in most cases. Successful management of traumatic esophageal injuries requires prompt and accurate diagnosis and treatment tailored specifically to both the type of injury as well as to the patient's overall clinical condition.
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Affiliation(s)
- Scott B Johnson
- Division of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.
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