1
|
Chen Y, Jia Y, Peng Z, Lv Z, Wang G. Successful Management of Esophageal Perforation by Intraoperative Microscopy and Esophagoscopic Assistance: A Case Report. EAR, NOSE & THROAT JOURNAL 2022; 101:526-531. [PMID: 35687016 DOI: 10.1177/01455613221091083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Surgical repair of esophageal perforation is a challenging procedure with a high risk of secondary complications, such as early esophageal leakage and late esophageal stricture, which can significantly reduce the patient's quality of life. A 34-year-old man underwent anterior cervical corpectomy decompression and fusion. On the ninth day post-operation, the patient developed fever and neck swelling. A computed tomography scan of the neck showed multiple subcutaneous pneumatosis. An esophageal perforation of approximately 1.5 cm in diameter was identified by esophagoscopy. During the operation, the fistula was first located using an esophagoscope. The distal end of the esophagoscope was then placed into the stomach to support the damaged segment of the esophagus. The esophageal mucosa was sutured under the microscope, and the perforation was successfully repaired. Postoperatively, the patient's body temperature decreased, and the infection indexes gradually returned to normal. Three months after the operation, the esophagoscopic review showed complete healing of the perforation. Esophagoscopy plays an important role in diagnosing and repairing esophageal perforations. The esophagoscope provides direct visualization of the perforation during diagnosis and detects smaller and not yet fully penetrated esophageal injuries. During the repair process, the esophagoscope immobilizes the esophagus, prevents its movement and facilitates suturing, maintains proper dilatation of the esophagus, provides space for suturing, and prevents esophageal stricture.
Collapse
Affiliation(s)
- Yan Chen
- The People's Hospital of Baoan Shenzhen, Shenzhen, China
| | - Yukun Jia
- The People's Hospital of Baoan Shenzhen, Shenzhen, China
| | - Zhan Peng
- The People's Hospital of Baoan Shenzhen, Shenzhen, China
| | - Zhiwu Lv
- The People's Hospital of Baoan Shenzhen, Shenzhen, China
| | - Guangye Wang
- The People's Hospital of Baoan Shenzhen, Shenzhen, China
| |
Collapse
|
2
|
Walters B, Lovett A, Yang D, Ross E. “Bless you"- a case of oropharyngeal perforation secondary to sternutation. OTOLARYNGOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.xocr.2022.100444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
3
|
Sohda M, Saeki H, Kuwano H, Sakai M, Sano A, Yokobori T, Miyazaki T, Kakeji Y, Toh Y, Doki Y, Matsubara H. Current status of surgical treatment of Boerhaave's syndrome. Esophagus 2022; 19:175-181. [PMID: 34117586 DOI: 10.1007/s10388-021-00858-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Surgical treatment is usually required for Boerhaave's syndrome (post-emetic esophageal perforation), and the technique should be chosen based on the local infection status and patient's general condition. This study was performed to examine the current status of surgical treatment of Boerhaave's syndrome in Japan. METHODS Ninety-five patients with Boerhaave's syndrome who underwent surgical treatment from January 2010 to December 2015, obtained from a national survey were retrospectively analyzed. The details of each surgical treatment and the type of treatment performed according to the patients' characteristics were examined. RESULTS Primary closure was performed in 75 (78.9%) patients, T-tube insertion in 15 (15.8%), and esophagectomy in 5 (5.3%). The length of the postoperative stay was significantly shorter in patients who underwent primary closure (p = 0.0011). Esophagectomy tended to be performed more often in patients with a long perforation and was performed significantly more often in patients with a high C-reactive protein concentration (p = 0.0118). The postoperative hospital stay was significantly longer in patients with leakage of the primary closure site (p < 0.0001). As a result, leakage of the primary closure site was significantly correlated with a long duration from symptom onset to patient presentation (p = 0.042), diagnostic imaging of the intrathoracic perforation (p = 0.013), and abscess formation in the mediastinal cavity (p = 0.006). CONCLUSIONS Selection of an appropriate surgical procedure may contribute to reduced mortality rates in patients with esophageal rupture. With regard to primary closure, it is necessary to understand that leaks are likely to occur in patients with a long duration from symptom onset to presentation or with severe intrathoracic/mediastinal inflammation, and to select an appropriate surgical procedure in consideration of the degree of invasiveness and QOL.
Collapse
Affiliation(s)
- Makoto Sohda
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Hiroshi Saeki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Makoto Sakai
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Akihiko Sano
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Takehiko Yokobori
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tatsuya Miyazaki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Yoshihiro Kakeji
- Division of Gastro-Intestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasushi Toh
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| |
Collapse
|
4
|
Clinical features of idiopathic esophageal perforation compared with typical post-emetic type: a newly proposed subtype in Boerhaave's syndrome. Esophagus 2021; 18:663-668. [PMID: 33386506 DOI: 10.1007/s10388-020-00802-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/23/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND n our previous nationwide survey report on esophageal perforation, we proposed the existence of cases with idiopathic esophageal perforation at a certain rate. AIMS To elucidate the clinical characteristics of idiopathic esophageal perforation, we performed a comparative analysis between cases with idiopathic type and post-emetic type esophageal perforation. METHODS This study enrolled 139 patients with esophageal perforation (post-emetic type: idiopathic type = 115:24) as the subjects of nationwide survey on esophageal perforation. We conducted detailed studies on chief complaints, inflammatory responses, initial diagnosis, location and situation of the perforation site, time to therapeutic intervention, and prognosis between the two groups. RESULTS Compared with post-emetic type, cases of idiopathic type tended to exhibit rear-side perforation (p = 0.052) and significantly less presented chest pain (p = 0.002). Consequently, cases of idiopathic type significantly missed to diagnose as esophageal perforation compared with post-emetic type (p = 0.042). With regard to inflammatory response, cases of post-emetic type experienced hyperthermia compared with idiopathic type (p = 0.033). On the other hand, cases of idiopathic type exhibited significantly higher level of C-reactive protein than post-emetic type (p = 0.004). In addition, it took longer time until starting treatment in the cases of idiopathic type (p < 0.0001) and the cases of idiopathic type showed significantly worse prognosis than the cases of post-emetic type (p = 0.009). CONCLUSION This study first focused on the characteristics of idiopathic esophageal perforation that have been included in so-called Boerhaave's syndrome. The pathophysiology of the idiopathic type should be separately understood from post-emetic type, because the diagnostic and prognostic features largely differ.
Collapse
|
5
|
Hanajima T, Kataoka Y, Masuda T, Asari Y. Usefulness of lavage and drainage using video-assisted thoracoscopic surgery for Boerhaave's syndrome: a retrospective analysis. J Thorac Dis 2021; 13:3420-3425. [PMID: 34277038 PMCID: PMC8264720 DOI: 10.21037/jtd-20-2445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 04/22/2021] [Indexed: 11/23/2022]
Abstract
Background Boerhaave’s syndrome has a high mortality rate due to respiratory failure, septic shock, and multiple organ failure. We had previously carried out primary repair with laparotomy and postoperative computed tomography-guided drainage for mediastinal abscess and empyema. However, this treatment prolonged mechanical ventilator days and length of intensive care unit stay. Therefore, we decided to carry out primary repair with laparotomy and add lavage and drainage using video-assisted thoracoscopic surgery. Methods From April 2004 to September 2018, 18 patients with Boerhaave’s syndrome were treated; 6 patients treated conservatively were excluded. Thus, 12 patients who underwent surgical treatment were divided into the computed tomography-guided drainage group (D group) (6 patients) and the lavage and drainage using video-assisted thoracoscopic surgery group (VATS group) (6 patients), and the two groups were retrospectively compared. Results The VATS group had significantly longer operation time than the D group {359 [328, 387] vs. 220 [155, 235] min, P=0.004}, but the ventilator-free days (VFDs) were significantly extended {24 [21, 24] vs. 10 [0, 17] days, P=0.02}, and the length of intensive care unit stay was significantly shortened {14 [8, 14] vs. 35 [29, 55] days, P=0.01}. Conclusions Lavage and drainage using video-assisted thoracoscopic surgery is an effective surgical method for Boerhaave’s syndrome.
Collapse
Affiliation(s)
- Tasuku Hanajima
- Department of Emergency and Critical Care Medicine, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Yuichi Kataoka
- Department of Emergency and Critical Care Medicine, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Tomonari Masuda
- Department of Emergency and Critical Care Medicine, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Yasushi Asari
- Department of Emergency and Critical Care Medicine, School of Medicine, Kitasato University, Kanagawa, Japan
| |
Collapse
|
6
|
Amirian A, Shahriarirad R, Mardani P, Salimi M. Non-operative management of bilateral contained thoracic esophageal perforation: a case report. BMC Surg 2021; 21:129. [PMID: 33711959 PMCID: PMC7953744 DOI: 10.1186/s12893-021-01121-6] [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: 11/11/2020] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite profound advances in conservative management of esophageal perforation, patients' selection for this type of treatment requires expert clinical judgment. Surgical intervention has been historically introduced as the optimal management in multifocal ruptures. CASE PRESENTATION Here, we presented a 30-year-old man whose barium esophagogram confirmed bilateral perforations in the lower third of the esophagus contained in the mediastinum, and contrast drained back into the esophageal lumen. Concerning available contrast imaging studies and thoracic surgeons, conservative non-operative management was considered despite pneumomediastinum, a mild right-sided pleural effusion, and minimal leukocytosis. The patient was followed up for two months without any complications. CONCLUSIONS Bilateral and multifocal esophageal perforations can be managed conservatively provided that the leaks are confined to the mediastinum and drain back to the esophageal lumen, and other criteria for conservative management are met.
Collapse
Affiliation(s)
- Armin Amirian
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parviz Mardani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Salimi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
7
|
Hayakawa S, Ogawa R, Ito S, Nakaya S, Okubo T, Sagawa H, Tanaka T, Takahashi H, Matsuo Y, Takiguchi S. Suitable Diagnosis and Treatment of Esophageal Ruptures in Cases of Non-Boerhaave Syndrome: A Comparison With Boerhaave Syndrome. J Investig Med High Impact Case Rep 2021; 9:23247096211014683. [PMID: 33985358 PMCID: PMC8127747 DOI: 10.1177/23247096211014683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/31/2021] [Accepted: 04/10/2021] [Indexed: 11/17/2022] Open
Abstract
Boerhaave syndrome (BS) is frequently reported in cases of esophageal perforation; however, there are relatively few studies on non-Boerhaave syndrome (nBS). This study clarifies the appropriate diagnosis and treatment for patients with nBS among those with esophageal ruptures. Twelve patients with esophageal ruptures who underwent surgery at our department over 14 years were classified into 2 groups: 4 in the nBS group and 8 in the BS group. Patient characteristics, surgical methods, surgical outcomes, and complications were compared between the groups. The chief complaints varied between the groups. The nBS group had significantly higher preoperative C-reactive protein (P = .007) and required 5 days (median) from onset to surgery. Moreover, the perforation diameter was significantly smaller in the nBS group than in the BS group (P = .013). Suturing of the perforation site was performed during the initial surgery in 8 BS group patients (100%) and 1 nBS group patient (25%; P = .018). Only drainage was performed during the initial surgery for 3 nBS group patients (75%). The complications did not significantly differ between the groups (P = 1.000), and no deaths were reported. The chief complaints of patients with nBS are diverse, and esophageal perforation should be cited as a differential diagnosis even in the absence of vomiting or chest pain symptoms. In the initial surgery for patients with nBS, the perforation site does not necessarily need to be closed. It is treatable by second-stage surgery or by natural closing.
Collapse
Affiliation(s)
| | - Ryo Ogawa
- Nagoya City University, Nagoya City, Japan
| | - Sunao Ito
- Nagoya City University, Nagoya City, Japan
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Wang CT, Jiang H, Walline J, Li Y, Wang J, Xu J, Zhu HD. Tension hydropneumothorax in a Boerhaave syndrome patient: A case report. World J Emerg Med 2021; 12:235-237. [PMID: 34141042 DOI: 10.5847/wjem.j.1920-8642.2021.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Chun-Ting Wang
- Emergency Department, Peking Union Medical College Hospital, Beijing 100730, China
| | - Hui Jiang
- Emergency Department, Civil Aviation General Hospital, Beijing 100123, China
| | - Joseph Walline
- Accident and Emergency Medicine Academic Unit, the Chinese University of Hong Kong, Hong Kong 999077, China
| | - Yan Li
- Emergency Department, Peking Union Medical College Hospital, Beijing 100730, China
| | - Jian Wang
- Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Jun Xu
- Emergency Department, Peking Union Medical College Hospital, Beijing 100730, China
| | - Hua-Dong Zhu
- Emergency Department, Peking Union Medical College Hospital, Beijing 100730, China
| |
Collapse
|
9
|
Veltri A, Weindelmayer J, Alberti L, De Pasqual CA, Bencivenga M, Giacopuzzi S. Laparoscopic transhiatal suture and gastric valve as a safe and feasible treatment for Boerhaave's syndrome: an Italian single center case series study. World J Emerg Surg 2020; 15:42. [PMID: 32611429 PMCID: PMC7329525 DOI: 10.1186/s13017-020-00322-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Boerhaave’s syndrome (BS) is a rare life-threating condition with poor prognosis. Unfortunately, due to its very low incidence, no clear evidences or definitive guidelines are currently available: in detail, surgical strategy is still a matter of debate. Most of the case series reports thoracic approach as the most widely used; conversely, transhiatal abdominal management is just described in sporadic case reports. In our center, the laparoscopic approach has been adopted for years: in the present study, we aim to show his feasibility by reporting the outcomes of the largest clinical series available to date. Methods Clinical records of patients admitted for BS to the General and Upper GI Surgery Division of Verona from February 2014 to December 2019 were retrospectively collected. Clinico-pathological characteristics, preoperative workup, surgical management, and outcomes were analyzed. Results Seven patients were admitted; epigastric/thoracic pain and vomiting were the most frequent symptoms at diagnosis. Laboratory findings were not specific; conversely, radiological imaging always revealed abnormal findings: particularly, CT had excellent sensitivity in detecting signs of esophageal perforation. All but one case had diagnostic workup and received surgery within 24 h. Every patient had laparoscopic transhiatal direct suture and gastric valve; 2 patients (28.6%) also needed a thoracoscopic toilette. Postoperative complications occurred in 4 patients (57%), but in only two of them (29%), the complication was severe according to Clavien-Dindo classification (both received thoracentesis or thoracic drainage for pleural effusion). Of note, no cases of postoperative esophageal leak were recorded. Postoperative mortality was 14% due to one patient who died for cardiovascular complications. Most of the patients (71.4%) were admitted to ICU after surgery (average length, 8.8 days); mean hospital stay was 14.7 days. No patients had readmissions. Conclusions To our knowledge, this is the largest case series reporting laparoscopic management of BS. We show that laparoscopy is a safe and feasible approach associated with a shorter length of hospital stay when compared with clinical series in which thoracic approach had been chosen. Of note, laparoscopic management would be easily adopted by surgical centers treating benign gastro-esophageal junction entailing a proper management more widely.
Collapse
Affiliation(s)
- A Veltri
- General and Upper GI Surgery Division, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani, 1, 37126, Verona, Italy. .,Upper G.I. Surgery Division, Department of General Surgery, University of Verona, 37126, Verona, Italy.
| | - J Weindelmayer
- Upper G.I. Surgery Division, Department of General Surgery, University of Verona, 37126, Verona, Italy
| | - L Alberti
- Upper G.I. Surgery Division, Department of General Surgery, University of Verona, 37126, Verona, Italy
| | - C A De Pasqual
- Upper G.I. Surgery Division, Department of General Surgery, University of Verona, 37126, Verona, Italy
| | - M Bencivenga
- Upper G.I. Surgery Division, Department of General Surgery, University of Verona, 37126, Verona, Italy
| | - S Giacopuzzi
- Upper G.I. Surgery Division, Department of General Surgery, University of Verona, 37126, Verona, Italy
| |
Collapse
|
10
|
Yan XL, Jing L, Guo LJ, Huo YK, Zhang YC, Yan XW, Deng YZ. Surgical management of Boerhaave's syndrome with early and delayed diagnosis in adults: a retrospective study of 88 patients. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:669-674. [PMID: 32496118 DOI: 10.17235/reed.2020.6746/2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND spontaneous esophageal rupture (Boerhaave's syndrome) is a rare and challenging clinical condition. OBJECTIVE to evaluate the outcome of different surgical treatments for patients with Boerhaave's syndrome with an early diagnosis (< 24 h) and delayed diagnosis (> 24 h), using a retrospective cohort study in a tertiary referral center. PATIENTS AND METHODS eighty-eight patients with Boerhaave's syndrome who underwent surgical treatment were identified from March 1994 to March 2019 in the First Hospital of Shanxi Medical University. Subsequently, they were retrospectively divided into two groups according to time from symptom onset to diagnosis (group 1, < 24 h, n = 16; group 2, > 24 h, n = 72). Primary suture repair was used in group 1 and reinforcement with a vascular muscle flap was used in group 2, in order to reduce the incidence of fistula. Patients in group 2 were further divided into two subgroups according to reinforcement using diaphragmatic flaps (subgroup 1) or intercostal muscle flaps (subgroup 2). RESULTS the duration of hospitalization and stay in Intensive Care Unit (ICU) was significantly shorter in group 1 (p = 0.027 and p = 0.001). Group 1 had fewer postoperative esophageal leaks (p = 0.037) compared to group 2. Various aspects were compared in the two subgroups and the differences were not statistically significant (p > 0.05). CONCLUSIONS it is very important to establish an early diagnosis for patients with Boerhaave's syndrome. Early (< 24 h) and primary suture repair is superior to delayed (> 24 h) primary repair, even for those reinforced with vascular muscle flaps. Furthermore, repair reinforcement with different muscle flaps appears to render similar results for patients with delayed diagnosis.
Collapse
Affiliation(s)
- Xiao-Liang Yan
- Cardiothoracic Surgery, The First Hospital of Shanxi Medical University, china
| | - Li Jing
- Cardiothoracic Surgery, The First Hospital of Shanxi Medical University,
| | - Lin-Jing Guo
- Cardiothoracic Surgery, The First Hospital of Shanxi Medical University,
| | - Yun-Kui Huo
- Cardiovascular Surgery, The First Hospital of Shanxi Medical University,
| | - Yong-Cai Zhang
- Cardiovascular Surgery, The First Hospital of Shanxi Medical University,
| | - Xiu-Wen Yan
- Cardiothoracic Surgery, The First Hospital of Shanxi Medical University,
| | - Yong-Zhi Deng
- Cardiovascular Surgery, The Affiliated Cardiovascular Hospital of Shanxi Medical University,
| |
Collapse
|
11
|
Khan J, Laurikka J, Laukkarinen J, Toikkanen V, Ukkonen M. The incidence and long-term outcomes of esophageal perforations in Finland between 1996 and 2017 - a national registry-based analysis of 1106 esophageal perforations showing high early and late mortality rates and better outcomes in patients treated at high-volume centers. Scand J Gastroenterol 2020; 55:395-401. [PMID: 32233883 DOI: 10.1080/00365521.2020.1746392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Esophageal perforations cause severe life-threatening diseases with significant mortality and morbidity. The national incidence and long-term prognosis of these patients is incompletely described in the current literature.Methods: Information regarding each treatment episode for esophageal perforations that had occurred in Finland between 1996 and 2017 and survival data of each patient was obtained from national registries. The occurrence of the disease, related interventions, the number and type of later treatment episodes, as well as the prognosis of these patients was analyzed.Results: The total number of patients with esophageal perforations was 1106 (median age 65, 38% female) and the median follow-up time was 113 months. The overall incidence of the disease was 0.95 (95% CI ± 0.12) per 100,000 person years with male predominance and a trend for slightly increasing occurrence. Esophageal cancer was present in 5.8% of cases. Altogether 41% of patients underwent invasive treatment (31% endoscopic stenting, 69% surgery). Particularly stenting was more frequent later in the series. The median number of disease-related hospitalizations was two and later out-patient clinic visits four. The overall 30-day, 90-day, 1-year and 5-year mortality rates were 14%, 22%, 31% and 46%, respectively, and significantly higher in malignancy-associated cases. There were no clear improvements in the mortality rates over the study period, but the prognosis was better in patients that were treated in higher volume hospitals.Conclusion: There is a slightly increasing trend in the occurrence of esophageal perforations. Contemporary treatment is less invasive with similar results. Patients treated in high-volume hospitals have better prognosis.
Collapse
Affiliation(s)
- Jahangir Khan
- Department of Cardio-Thoracic Surgery, Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Jari Laurikka
- Department of Cardio-Thoracic Surgery, Tays Heart Hospital, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Johanna Laukkarinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Vesa Toikkanen
- Department of Cardio-Thoracic Surgery, Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Mika Ukkonen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
12
|
Abstract
PURPOSE Esophageal perforation constitutes a potentially life-threatening condition, and this study aimed to evaluate the indications and outcome for the different treatment modalities. PATIENTS AND METHODS In total, 43 patients with esophageal perforation were considered for this retrospective analysis. Age, sex, length of hospital stay and intensive care treatment, in-hospital mortality, localization of perforation and etiology, treatment modality, and 90-day morbidity were analyzed. RESULTS Most patients suffered from Boerhaave syndrome and from iatrogenic esophageal perforation. In total, 63% of patients (26/41) received successful nonoperative treatment, whereas 36% required additional surgery. Two patients (5%) underwent primary surgery. In all cases no esophagectomy was necessary. In-hospital mortality was 7%. During the 90-day follow-up 1 patient with stenosis required repetitive dilatations. CONCLUSIONS Initial endoscopic treatment, either by stent or by endosponge, alone or combined with an additional operative treatment, seems feasible in patients suffering from esophageal perforation. In all patients, there was no need for esophagectomy.
Collapse
|
13
|
Okamoto H, Onodera K, Kamba R, Taniyama Y, Sakurai T, Heishi T, Teshima J, Hikage M, Sato C, Maruyama S, Onodera Y, Ishida H, Kamei T. Treatment of spontaneous esophageal rupture (Boerhaave syndrome) using thoracoscopic surgery and sivelestat sodium hydrate. J Thorac Dis 2018; 10:2206-2212. [PMID: 29850124 DOI: 10.21037/jtd.2018.03.136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The mortality rate of spontaneous esophageal rupture remains 20% to 40% due to severe respiratory failure. We have performed thoracoscopic surgery for esophageal disease at our department since 1994. Sivelestat sodium hydrate reportedly improves the pulmonary outcome in the patients with acute lung injury (ALI). Methods We retrospectively evaluated the usefulness of thoracoscopic surgery and perioperative administration of sivelestat sodium hydrate for spontaneous esophageal rupture in 12 patients who underwent thoracoscopy at our department between 2002 and 2014. Results The patient cohort included 11 males and one female (median age, 61 years). The lower left esophageal wall was perforated in all patients. Surgical procedures consisted of thoracoscopic suture and thoracic drainage in six patients, transhiatal suture and thoracoscopic thoracic drainage in five, and thoracoscopic esophagectomy and thoracic drainage in one. The median time from onset to surgery was 8 hours with a surgical duration of 210 minutes, blood loss 260 mL, postoperative ventilator management 1 day, intensive care unit (ICU) stay 5 days, and interval to restoration of oral ingestion 13 days. Postoperative complications included respiratory failure in four patients, pyothorax in three, and leakage in one. There was no instance of perioperative mortality. Regarding perioperative administration of sivelestat sodium hydrate, the postoperative arterial oxygen partial pressure-to-fractional inspired oxygen ratio (P/F) and C-reactive protein (CRP) levels in the administration group were significantly better than those in the non-administration group on postoperative days 4 (P=0.035) and 5 (P=0.037), respectively. In contrast, there was no significant difference between the groups in median time of ventilator management, ICU stay, oral ingestion following surgery, or hospital stay. Conclusions Thoracoscopic surgery obtained acceptable results in all patients, including two with a significant time elapse from onset to treatment. Furthermore, sivelestat sodium hydrate was suggested to help improve postoperative respiration and inflammatory response.
Collapse
Affiliation(s)
- Hiroshi Okamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Ko Onodera
- Department of General Practitioner Development, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Rikiya Kamba
- Department of Surgery, Osaki Citizen Hospital, Osaki, Japan
| | - Yusuke Taniyama
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Tadashi Sakurai
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Takahiro Heishi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Jin Teshima
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan.,Department of Surgery, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Makoto Hikage
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan.,Department of Surgery, Sendai City Hospital, Sendai, Japan
| | - Chiaki Sato
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Shota Maruyama
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Yu Onodera
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Hirotaka Ishida
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Takashi Kamei
- Department of Gastroenterological Surgery, Graduate School of Medicine, Graduate School of Medicine, Tohoku University, Sendai, Japan
| |
Collapse
|
14
|
Eroglu A, Aydin Y, Yilmaz O. Thoracic perforations-surgical techniques. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:40. [PMID: 29610732 DOI: 10.21037/atm.2017.04.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Esophageal perforation may occur spontaneously, iatrogenically or in connection with traumas. Sepsis may develop in connection with mediastinal and pleural exposure in a very short time as a consequence of disintegration of the esophagus. Esophageal perforation is an emergency accompanied with a high level of mortality and morbidity. Rate of mortality for the perforations in the thoracic region is higher than that in the cervical and abdominal regions. Delay in diagnosis and treatment is the most important factor to affect the mortality. A quick and true diagnosis of esophageal perforation is prerequisite for a successful treatment. There is no certain consensus in relation with the optimal treatment of that life-threatening condition. However, in the event that perforation is detected early in a healthy esophagus, then primary repair is recommended. When it is detected late, nonoperative conservative treatment would be appropriate. The rates of mortality for the operations following a period of 24 h after rupture formation are higher than 50%. Esophagectomy is a type of an operation that is to be considered in the event of an end stage benign esophageal disease or of a large esophageal damage that does not allow primary repair. Significant decrease has been observed in the morbidity and mortality of esophageal perforation due to the improvements in the endoscopical techniques today. Minimally invasive techniques, in which drug eluting stents come first, will become an important step for the treatment of esophageal perforations in the forthcoming years.
Collapse
Affiliation(s)
- Atilla Eroglu
- Department of Thoracic Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Yener Aydin
- Department of Thoracic Surgery, Medical Faculty, Ataturk University, Erzurum, Turkey
| | - Omer Yilmaz
- Department of Gastroenterology, Medical Faculty, Ataturk University, Erzurum, Turkey
| |
Collapse
|
15
|
Yang W, Sahota RS, Das S. Snap, crackle and pop: when sneezing leads to crackling in the neck. BMJ Case Rep 2018; 2018:bcr-2016-218906. [PMID: 29335355 DOI: 10.1136/bcr-2016-218906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Spontaneous perforation of the pharynx is an unusual condition. Due to its non-specific presentation and general lack of awareness, diagnosis and intervention may be delayed resulting in potential complications. This case reports a rare spontaneous perforation of the pyriform sinus after a forceful sneeze, leading to cervical subcutaneous emphysema and pneumomediastinum.
Collapse
Affiliation(s)
- Wanding Yang
- ENT, Head and Neck Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Raguwinder S Sahota
- ENT, Head and Neck Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sudip Das
- ENT, Head and Neck Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| |
Collapse
|
16
|
Outcome of stent grafting for esophageal perforations: single-center experience. Surg Endosc 2017; 31:3696-3702. [PMID: 28078464 DOI: 10.1007/s00464-016-5408-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/21/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent studies showed that stent grafting is a promising technique for treatment of esophageal perforation. However, the evidence of its benefits is still scarce. METHODS Forty-three consecutive patients underwent stent grafting for esophageal perforation at the Oulu University Hospital, Finland. The main endpoints of this study were early and mid-term mortality. Secondary outcome endpoints were the need of esophagectomy and additional surgical procedures on the esophagus and extraesophageal structures. RESULTS Patients' mean age was 64.6 ± 13.4 years. The mean delay to primary treatment was 23 ± 27 h. The most frequent cause of perforation was Boerhaave's syndrome (46.5%). The thoraco-abdominal segment of the esophagus was affected in 58.1% of cases. Minor primary procedures were performed in 25 patients (58.1%) and repeat surgical procedures in 23 patients (53.5%). Forty-nine repeat stent graftings were performed in 22 patients (50%). Two patients (4.7%) underwent esophagectomy, one for unrelenting preprocedural stricture of the esophagus and another for persistent leakage of a perforated esophageal carcinoma. The mean length of stay in the intensive care unit was 6.0 ± 7.5 days and the in-hospital stay was 24.3 ± 19.6 days. In-hospital mortality was 4.6%. Three-year survival was 67.2%. CONCLUSIONS Stent grafting seems to be an effective less invasive technique for the treatment of esophageal perforation. Repeat stent grafting and procedures on the pleural spaces are often needed to control the site of perforation and for debridement of surrounding infected structures. Stent grafting allows the preservation of the esophagus in most of patients. The mid-term survival of these patients is suboptimal and requires further investigation.
Collapse
|