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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Habenbacher M, Andrianakis A. Swallowed denture stuck in the proximal esophagus. Wien Med Wochenschr 2024:10.1007/s10354-024-01040-0. [PMID: 38635109 DOI: 10.1007/s10354-024-01040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/15/2024] [Indexed: 04/19/2024]
Abstract
A 72-year-old male with dementia and Parkinson's disease presented at the otorhinolaryngology outpatient clinic with acute dysphagia. A chest x‑ray showed a dental prosthesis in the upper esophagus, which was subsequently extracted via rigid esophagoscopy. Due to suspected esophageal perforation on postoperative CT, a cervical approach to the esophagus and flexible esophagoscopy were used, but no evidence of perforation could be identified. This case highlights challenges in managing high-risk esophageal foreign bodies in the upper esophagus, emphasizing the need for careful assessment and a multidisciplinary approach.
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Affiliation(s)
- Michael Habenbacher
- Department of Otorhinolaryngology, Medical University of Graz, Graz, Austria
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3
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de Oliveira AT, Barreira MA, da Cunha Parente Júnior JW, Junior JRLH, Ribeiro JBES, de Azevedo OGR, de Vasconcelos PRC. Endoscopic self-expandable metal stent versus endoscopy vacuum therapy for traumatic esophageal perforations: a retrospective cohort study. Surg Endosc 2024; 38:2142-2147. [PMID: 38448621 PMCID: PMC10978687 DOI: 10.1007/s00464-024-10755-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/16/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Traumatic esophageal perforations (TEP) are a grave medical condition and require immediate intervention. Techniques such as Esophageal Self-Expandable Metal Stent (E-SEMS) and Endoscopic Vacuum Therapy (EVT) show promise in reducing tissue damage and controlling esophageal leakage. The present study aims to compare the application of EVT to E-SEMS placement in TEP. METHODS Retrospective cohort study valuated 30 patients with TEP. The E-SEMS and EVT groups were assessed for time of hospitalization, treatment duration, costs, and clinical outcome. RESULTS Patients treated with EVT (24.4 ± 13.2) demonstrated significantly shorter treatment duration (p < 0.005) compared to the group treated with E-SEMS (45.8 ± 12.9) and patients submitted to E-SEMS demonstrated a significant reduction (p = 0.02) in the time of hospitalization compared to the EVT (34 ± 2 vs 82 ± 5 days). Both groups demonstrated a satisfactory discharge rate (E-SEMS 93.7% vs EVT 71.4%) but did not show statistically significant difference (p = 0.3155). E-SEMS treatment had a lower mean cost than EVT (p < 0.05). Descriptive statistics were utilized, arranged in table form, where frequencies, percentages, mean, median, and standard deviation of the study variables were calculated and counted. The Fisher's Exact Test was used to evaluate the relationship between two categorical variables. To evaluate differences between means and central points, the parametric t-test was utilized. Comparisons with p value up to 0.05 were considered significant. CONCLUSION E-SEMS showed a shorter time of hospitalization, but a longer duration of treatment compared to EVT. The placement of E-SEMS and EVT had the same clinical outcome. Treatment with E-SEMS had a lower cost compared with EVT.
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Affiliation(s)
- Alessandrino Terceiro de Oliveira
- Department of Digestive Endoscopy, Dr. José Frota Institute, Fortaleza, CE, Brazil.
- Department of Surgery, Federal University of Ceara, Fortaleza, CE, Brazil.
- Department of Digestive Endoscopy, General Hospital of Fortaleza, Fortaleza, CE, Brazil.
- Department of Surgery, Federal University of Ceara, 1608 N. Prof Costa Mendes St, 3rd Floor, Fortaleza, CE, 60416-200, Brazil.
| | - Márcio Alencar Barreira
- Department of Surgery, Federal University of Ceara, Fortaleza, CE, Brazil
- Department of Surgery, Dr. José Frota Institute, Fortaleza, CE, Brazil
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4
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Rollo G, De Angelis P, Torroni F, Balassone V, Iolanda Contini AC, Faraci S, Romeo EF, Dall'Oglio L, Caldaro T. Replogle Modified Endoscopic Vacuum-Assisted Closure (EVAC) Therapy: A New Strategy to Treat Anastomotic Leakage and Esophageal Perforation. J Pediatr Surg 2024; 59:432-436. [PMID: 37949689 DOI: 10.1016/j.jpedsurg.2023.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Anastomotic leakage (AL) and esophageal perforation are life-threatening complications following surgery or endoscopic dilations. "Replogle modified EVAC therapy" consists of placing a Replogle tube directly into the lumen or within an abscess cavity and remove by suction all intra-cavity fluids and secretion with a continuous low-pressure suction, promoting granulation tissue proliferation, thereby gradually decreasing the cavity size. The aim of our study was to evaluate the technical feasibility, safety, and efficacy of this technique in pediatric patients. METHODS A retrospective review charts of consecutive pediatric patients that were treated with "Replogle modified EVAC therapy" at our pediatric referral center between 2013 and 2022 was conducted. The clinical, endoscopic, radiological, and surgical information and data of patients were collected and revised as well as their follow-up and outcomes. RESULTS Ten patients (6/10 male; mean age: 7.8 y.o., range: 1.1-18 y.o.) were treated using the "Replogle modified EVAC therapy". Four out of ten patients developed esophageal perforations after endoscopic procedures. Six out of the ten enrolled patients had AL complications after surgical operations. All patients were successfully treated. There were no technical failures or complications with device placement. Mean treatment duration was 16 days (range 7-41 days). No additional treatment was needed for complete leak resolution. CONCLUSIONS "Replogle modified EVAC therapy" represents a promising and mini-invasive method to treat esophageal perforations and post-surgical leak in the paediatric age group. In our experience, the use of this technique was safe, effective, and particularly well suited also in complex paediatric patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Giovanni Rollo
- University of Rome "Tor Vergata", Rome, Italy; Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS Rome, Italy.
| | - Paola De Angelis
- Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Filippo Torroni
- Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valerio Balassone
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS Rome, Italy
| | | | - Simona Faraci
- Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Luigi Dall'Oglio
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS Rome, Italy
| | - Tamara Caldaro
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS Rome, Italy
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Arruda T, Nina V, Souza Filho N, Marath A, Abreu JP. Esophageal Perforation by Fish Bone Ingestion Causing Purulent Pericarditis. ACG Case Rep J 2024; 11:e01291. [PMID: 38445259 PMCID: PMC10914229 DOI: 10.14309/crj.0000000000001291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/22/2024] [Indexed: 03/07/2024] Open
Abstract
A previously healthy 38-year-old woman presented with new-onset sudden chest pain radiating to the back, associated with cough, dyspnea, nausea, vomiting, and gastric fullness after eating a bony fish. A diagnosis of gastroesophageal reflux disease was made. After a week of progressive worsening of her symptoms, she was referred to the specialist hospital. There, computed tomography imaging strongly suggested that a likely fishbone had penetrated the esophagus into the mediastinal structures; it seemed to have produced a pneumopericardium. Other tests suggested diffuse changes in ventricular repolarization, pericardial thickening, and diastolic restriction. Exploratory thoracotomy confirmed esophageal-pericardial perforation by the fishbone and purulent pericarditis. Despite appropriate surgical repair, the patient died on fifth postoperative day from an asystolic cardiac arrest that was refractory to repeated attempts to resuscitate her.
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Affiliation(s)
- Tamara Arruda
- Department of Cardiovascular Surgery, University Hospital of the Federal University of Maranhão/HU-UFMA, São Luís, Maranhão, Brazil
| | - Vinícius Nina
- Department of Cardiovascular Surgery, University Hospital of the Federal University of Maranhão/HU-UFMA, São Luís, Maranhão, Brazil
| | - Nilo Souza Filho
- Department of Thoracic Surgery, University Hospital of the Federal University of Maranhão/HU-UFMA, São Luís, Maranhão, Brazil
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Papadakos D, Fermeli D, Tsipouriaris P, Vrettos T, Mastronikolis N, Constantoyannis C. Delayed postoperative erosion of hypopharynx after anterior hardware extrusion: A case report. Surg Neurol Int 2024; 15:47. [PMID: 38468679 PMCID: PMC10927207 DOI: 10.25259/sni_980_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/18/2024] [Indexed: 03/13/2024] Open
Abstract
Background Esophageal breach or pharynx perforations are serious and potentially fatal complications of anterior cervical corpectomy/fusion (ACF). They are either recognized intraoperatively or are diagnosed within several postoperative days. Here, a 76-year-old male presented with the retropharyngeal extrusion of an anterior cervical expandable cage that occurred two years postoperatively. Case Description A 76-year-old male with a history of an anterior corpectomy/fusion (C3-C6, corpectomy C4, C5) performed two years ago presented with persistent dysphagia for three months. Cervical X-rays showed anterior migration of the expandable cage and that was also confirmed by computed tomography (CT) scans. During intubation, the anesthesiologist observed that the cage had directly penetrated the hypopharynx. Following routine removal of the cage, ENT could not identify (using the operating microscope) any direct perforation of the esophagus or hypopharynx; presumably, the esophageal breach was small, and the esophageal wall spontaneously closed the gap following cage excision. Conclusion Pharyngeal perforation after ACF is typically associated with significant morbidity and mortality. Stringent preoperative assessment, utilizing X-rays, magnetic resonance/CT studies, and ENT specialists to perform indirect laryngoscopy, may optimize postoperative outcomes.
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Affiliation(s)
| | - Dionysia Fermeli
- Department of Neurosurgery, University Hospital of Patras, Patras, Greece
| | | | - Theofanis Vrettos
- Department of Anesthesiology and ICU, University Hospital of Patras, Patras, Greece
| | - Nikolaos Mastronikolis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Patras, Patras, Greece
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7
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Fukunaga A, Ikushima T, Aoki Y, Kuwabara S, Kato T, Hirano S. Esophageal perforation due to soft coagulation heat injury after right lower lobectomy: A case report. Int J Surg Case Rep 2024; 115:109247. [PMID: 38219514 PMCID: PMC10826808 DOI: 10.1016/j.ijscr.2024.109247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/05/2024] [Accepted: 01/06/2024] [Indexed: 01/16/2024] Open
Abstract
INTRODUCTION Soft coagulation is a hemostatic system of electrosurgical units that automatically regulates its output to avoid carbonization or incision. This system is widely used in invasive procedures, including thoracic surgery. Few reports exist on the harmful effects of these devices. Herein, we encountered a case of an esophagopleural fistula caused by soft coagulation. PRESENTATION OF CASE A 74-year-old man with a history of bladder cancer was diagnosed with a tumor in the right lower lung lobe 2.5 cm in diameter. A thoracoscopic right lower lobectomy with lymph node dissection was performed. During surgery, hemostasis using soft coagulation was performed on the right wall of the lower esophagus. Eight days after surgery, thoracoscopic empyema curettage and drainage were performed. Three days after the second surgery, an esophageal fistula was identified. Suturing for the esophageal fistula and omentoplasty were performed. Suture failure occurred and an esophagobronchial fistula developed after the third surgery, which was reduced by drainage, antibiotics, and enteral nutrition. The fistula was finally addressed by fibrin glue filling in its cavity. DISCUSSION Soft coagulation helps manage hemostasis and contributes to safe surgery. However, it may cause severe complications owing to the unpredictable spread of heat denaturation. It is suspected that delayed esophageal perforation was caused by an unnoticed heat injury to the deeper layer of the esophageal wall. CONCLUSION There have been no reports of esophagus injury caused by soft coagulation exept for our experience. Although soft coagulation is a useful device owing to its excellent hemostatic capacity, the spread of heat denaturation may cause unpredictable tissue damage. Extra caution should be observed when using this device for hemostasis.
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Affiliation(s)
- Akira Fukunaga
- Department of Thoracic Surgery, Japanese Red Cross Asahikawa Hospital, Japan.
| | - Takuya Ikushima
- Department of Thoracic Surgery, Japanese Red Cross Asahikawa Hospital, Japan
| | - Yuma Aoki
- Department of Surgery, Japanese Red Cross Asahikawa Hospital 1-1, Akebono1-1, Asahikawa, Hokkaido 070-8530, Japan
| | - Shota Kuwabara
- Department of Surgery, Japanese Red Cross Asahikawa Hospital 1-1, Akebono1-1, Asahikawa, Hokkaido 070-8530, Japan
| | - Tatsuya Kato
- Department of Thoracic Surgery, Hokkaido University Hospital, 5-14 Kita-ku, Sapporo, Hokkaido 060-8648, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, 7-15 Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
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8
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Evans BA, Craig WY, Cinelli CM, Siegel SG. CT esophagogram in the emergency setting: typical findings and suggested workflow. Emerg Radiol 2024; 31:33-44. [PMID: 38093143 DOI: 10.1007/s10140-023-02193-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/27/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE Esophageal perforation (EP) can be a diagnostic challenge. Computed tomography (CT) and CT esophagography (CTE) are often used to rule out EP in the emergency setting with promising diagnostic performance, but the standard of care remains fluoroscopic esophagography (FE). We assess the diagnostic performance of CT and CTE when interpreted by expert and generalist radiologists and created an imaging workflow guide. METHODS Retrospective study of patients presenting with suspected EP. Two expert radiologists independently reviewed blinded CT/CTE studies, recorded CT findings, and assigned an esophageal injury grade. We also collected initial (general radiologist) CT findings and interpretation and FE diagnoses. We assessed inter-reader reliability and diagnostic performance. RESULTS EP was diagnosed in 46/139 (33%) encounters. The most common CT/CTE findings in EP were esophageal wall thickening (46/46, 100%), pneumomediastinum (42/46, 91%), and mediastinal stranding (39/46, 85%). CT and CTE sensitivity for detecting EP was 89% and 89% for expert radiologists, respectively, and 79% and 82% for general radiologists, compared with 46% for FE. Inter-reader agreement for detecting EP by CT and CTE was kappa 0.35 and 0.42 (both p < .001) between expert and generalist radiologists. We present radiographic images for key CT/CTE findings and a suggested workflow for the evaluation of possible EP. CONCLUSION CT and CTE are more sensitive than FE for EP in the emergency setting. Due to the rarity of EP and current wide variability in imaging interpretation, an imaging workflow and injury grading system based on esophageal and mediastinal CT findings are offered to help guide management.
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Affiliation(s)
- Brad A Evans
- Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA.
- University of Wisconsin, 750 Highland Ave., Madison, WI, 53705, USA.
| | - Wendy Y Craig
- MaineHealth Institute for Research, 81 Research Drive, Scarborough, ME, 04074, USA
| | - Christina M Cinelli
- Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA
- Spectrum Healthcare Partners, 324 Gannett Dr. Suite 200, South Portland, ME, 04106, USA
| | - Sharon G Siegel
- Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA
- Spectrum Healthcare Partners, 324 Gannett Dr. Suite 200, South Portland, ME, 04106, USA
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Estorninho J, Pimentel R, Gravito-Soares M, Gravito-Soares E, Amaro P, Figueiredo P. Successful Endoscopic Closure of Esophageal Perforation in Boerhaave Syndrome Using the Over-the-Scope Clip. GE Port J Gastroenterol 2023; 30:444-450. [PMID: 38476151 PMCID: PMC10928871 DOI: 10.1159/000527317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/30/2022] [Indexed: 03/14/2024]
Abstract
Boerhaave syndrome (BS) is a rare but potentially fatal condition. Although surgery is considered the standard treatment, endoscopic therapy has acquired an important role as a minimally invasive management approach. The authors describe 2 cases of middle-aged male patients, presenting with spontaneous esophageal perforation after severe straining and vomiting. In the first case, the patient presented with a bone impaction in the upper esophagus successfully removed by rigid esophagoscopy. After the procedure, a chest X-ray/cervicothoracic computerized tomography scan (CT) showed a left hydropneumothorax and pneumomediastinum with oral contrast leak at the lower esophagus. In the second case, the patient presented to the Emergency Department with severe chest pain after an episode of vomiting. The CT showed a massive pneumomediastinum, subcutaneous emphysema, and an oral contrast leak compatible with BS. The patient was initially submitted to surgical suture, but contrast extravasation persisted after 12 days. After multidisciplinary team discussion of both patients, an upper gastrointestinal endoscopy was performed, which revealed pericentimetric wall defects at the distal esophagus. These were successfully closed using an over-the-scope clip (OTSC). After at least a 9-month follow-up, patients have remained clinically well with no relapse. The authors highlight the severity of these clinical cases and the endoscopic option that proved to be decisive in addressing BS. The favorable outcomes suggest a role for the OTSC approach in closing spontaneous esophageal perforation both as first-line and as rescue therapy after a surgical failure.
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Affiliation(s)
- João Estorninho
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Raquel Pimentel
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Marta Gravito-Soares
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Elisa Gravito-Soares
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Pedro Amaro
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Pedro Figueiredo
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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10
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Zhao J, D'Souza DM. Thoracic Emergencies for the General Surgeon. Surg Clin North Am 2023; 103:1085-1095. [PMID: 37838457 DOI: 10.1016/j.suc.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
In this review article, we aim to provide an overview of common and uncommon general surgery thoracic emergencies as well as basic thoracic anatomy, common diagnostic tests, and operative positioning and access considerations. We also describe specific thoracic procedures. We hope that this article simplifies some of the challenges associated with the management of thoracic emergencies.
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Affiliation(s)
- Jane Zhao
- Division of Thoracic Surgery, Department of Surgery, The Ohio State Wexner Medical Center, 410 West 10th Avenue, N835 Doan Hall, Columbus, OH 43210, USA
| | - Desmond M D'Souza
- Division of Thoracic Surgery, Department of Surgery, The Ohio State Wexner Medical Center, 410 West 10th Avenue, N835 Doan Hall, Columbus, OH 43210, USA. Desmond.D'
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11
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Shaik MR, Shaik NA, Kunarathnam V, Bilgrami Z, Wheeler E, Hu S. Esophageal Perforation Unveiling the Diagnosis of Zollinger-Ellison Syndrome. J Community Hosp Intern Med Perspect 2023; 13:77-81. [PMID: 37868662 PMCID: PMC10589047 DOI: 10.55729/2000-9666.1228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/17/2023] [Accepted: 06/02/2023] [Indexed: 10/24/2023] Open
Abstract
Gastrinomas are the most common neuroendocrine tumors worldwide and cause a clinical syndrome known as Zollinger-Ellison Syndrome (ZES). Increased acid production resulting from elevated gastrin levels contributes to symptoms such as abdominal pain, heartburn, and diarrhea. However, the non-specificity and overlap in the symptoms with idiopathic peptic ulcer disease and gastroesophageal reflux disease (GERD) can lead to delayed diagnosis. In this case, we describe a patient with a past medical history of GERD and a perforated gastric ulcer who continued to experience symptoms of dyspepsia and had a subsequent esophageal perforation, despite H. pylori eradication and high-dose proton pump inhibitor (PPI) therapy. Multiple ulcers were visualized in the first portion of the duodenum, and metastatic lesions were demonstrable in the liver. Serum gastrin level was elevated to 433 pg/mL. Histology of liver biopsy showed a well-differentiated neuroendocrine tumor, supporting the diagnosis of ZES. This article underscores the significance of considering ZES in the differential in cases of refractory gastric hyperacidity and the importance of early diagnosis with serum gastrin testing to prevent complications such as gastric obstruction, perforation, hemorrhage, esophageal strictures, or rupture and to minimize the risk of metastasis. It is noteworthy that while perforations in cases of ZES typically occur in the duodenum, this particular case is atypical as it had involved the stomach. Furthermore, it was associated with esophageal perforation, likely resulting from forceful and prolonged vomiting caused by persistent dyspepsia.
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Affiliation(s)
- Mohammed R. Shaik
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD,
United States
| | - Nishat A. Shaik
- Department of Medicine, Guntur Medical College, Guntur, Andhra Pradesh,
India
| | - Vithura Kunarathnam
- Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD,
United States
| | - Zaid Bilgrami
- Department of Radiology, New York Presbyterian Hospital, New York,
United States
| | - Erika Wheeler
- Department of Pathology, University of Maryland Medical Center, Baltimore, MD,
United States
| | - Shien Hu
- Division of Gastroenterology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD,
United States
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12
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Wong LY, Leipzig M, Liou DZ, Backhus LM, Lui NS, Shrager JB, Berry MF. Surgical Management of Esophageal Perforation: Examining Trends in a Multi-Institutional Cohort. J Gastrointest Surg 2023; 27:1757-1765. [PMID: 37165161 DOI: 10.1007/s11605-023-05700-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/15/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Esophageal perforations historically are associated with significant morbidity and mortality and generally require emergent intervention. The influence of improved diagnostic and therapeutic modalities available in recent years on management has not been examined. This study examined the surgical treatments and outcomes of a modern cohort. METHODS Patients with esophageal perforation management in the 2005-2020 American College of Surgeons National Surgical Quality Improvement Program database were stratified into three eras (2005-2009, 2010-2014, and 2015-2020). Surgical management was classified as primary repair, resection, diversion, or drainage alone based on procedure codes. The distribution of procedure use, morbidity, and mortality across eras was examined. RESULTS Surgical management of 378 identified patients was primary repair (n=193,51%), drainage (n=89,24%), resection (n=70,18%), and diversion (n=26,7%). Thirty-day mortality in the cohort was 9.5% (n=36/378) and 268 patients (71%) had at least one complication. The median length of stay was 15 days. Both morbidity (Era 1 65% [n=42/60] versus Era 2 69% [n=92/131] versus Era 3 72% [n=135/187], p=0.3) and mortality (Era 1 11% [n=7/65] versus Era 2 9% [n=12/131] versus Era 3 10% [n=19/187], p=0.9) did not change significantly over the three defined eras. Treatment over time evolved such that primary repair was more frequently utilized (43% in Era 1 to 51% in Era 3) while diversion was less often performed (13% in Era 1 to 7% in Era 3) (p=0.009). CONCLUSIONS Esophageal perforation management in recent years uses diversion less often but remains associated with significant morbidity and mortality.
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Affiliation(s)
- Lye-Yeng Wong
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Palo Alto, California, USA.
| | - Matthew Leipzig
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Douglas Z Liou
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Leah M Backhus
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Natalie S Lui
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Joseph B Shrager
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Palo Alto, California, USA
| | - Mark F Berry
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Palo Alto, California, USA
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13
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Foula MS, Amer NM, Zakaria H, Ismail MH, Alshomimi SJ, Al Bisher HM, Alsaleem H, Almulhim K, Aldabaeab AE, Alratrout H, Alsadery HA, Alarfaj MA, Aljehani YM, El Damati AM. Surgical Management of Intra-gastric Balloon Complications, Single-Center Experience, and Literature Review. Obes Surg 2023; 33:2718-2724. [PMID: 37452985 DOI: 10.1007/s11695-023-06716-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION In Saudi Arabia, the prevalence of obesity has multiplied in the last decades leading to a surge in bariatric surgery and other endoscopic modalities. The intra-gastric balloon (IGB) is the most used endoscopic modality. Surgical management for IGB complications is required for gastrointestinal perforation and/or obstruction. However, the literature seems to underestimate these complications. MATERIALS AND METHODS A retrospective descriptive study was conducted in King Fahd University Hospital, Saudi Arabia, from Jan 2017 to Dec 2021, including all patients with complicated IGB who necessitated any surgical procedure. Exclusion criteria were patients with complicated IGBs that were only managed conservatively or endoscopically. RESULTS A total of 326 patients were admitted with different complications after bariatric procedures. Of them, six patients were referred due to IGB complications that necessitated operative intervention. All patients were young females. Three patients had gastric wall perforation, and were managed by endoscopic removal of the IGBs followed by exploratory laparotomy. One patient had an intestinal obstruction on top of a migrated IGB that was surgically removed. One patient had failed endoscopic retrieval of IGB and required a laparoscopic gastrostomy. Another patient had an esophageal rupture that required left thoracotomy, pleural flap, and insertion of an esophageal stent. All cases were discharged and followed up with no related complications. CONCLUSION IGB is an endoscopic alternative, within specific indications, for the management of obesity. However, surgical management may be necessary to manage its complications, including gastrointestinal perforation, IGB migration, and failure of endoscopic removal.
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Affiliation(s)
- Mohammed S Foula
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia.
| | - Nasser M Amer
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hazem Zakaria
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Mona H Ismail
- Division of Gastroenterology, Department of Internal Medicine, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Saeed J Alshomimi
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hassan M Al Bisher
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hassan Alsaleem
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Khalifa Almulhim
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Abdulaziz E Aldabaeab
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Hefzi Alratrout
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Humood A Alsadery
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Mosab A Alarfaj
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Yasser M Aljehani
- Department of Surgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Khobar, Saudi Arabia
| | - Ahmed M El Damati
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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14
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Fuentes KMI, Seastedt KP, Kidane B, Servais EL. Advanced Endoscopy for Thoracic Surgeons. Thorac Surg Clin 2023; 33:251-263. [PMID: 37414481 DOI: 10.1016/j.thorsurg.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
The thoracic surgeon, well versed in advanced endoscopy, has an array of therapeutic options for foregut pathologic conditions. Peroral endoscopic myotomy (POEM) offers a less-invasive means to treat achalasia, and the authors' preferred approach is described in this article. They also describe variations of POEM, such as G-POEM, Z-POEM, and D-POEM. In addition, endoscopic stenting, endoluminal vacuum therapy, endoscopic internal drainage, and endoscopic suturing/clipping are discussed and can be valuable tools for esophageal leaks and perforations. Endoscopic procedures are advancing rapidly, and thoracic surgeons must maintain at the forefront of these technologies.
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Affiliation(s)
- Kathleen M I Fuentes
- Department of General Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, USA
| | - Kenneth P Seastedt
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Biniam Kidane
- Department of Surgery, University of Manitoba, Room GE-611, 820 Sherbook Street, Winnipeg, Manitoba R3A 1R9, Canada
| | - Elliot L Servais
- Division of Thoracic Surgery, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, USA.
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15
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Madsen HJ, Stuart CM, Wojcik BM, Dyas AR, Hunt A, Helmkamp LJ, Gergen AK, Weyant MJ, Randhawa SK, Mitchell JD, Meguid RA. Esophagram should be performed to diagnose esophageal perforation before inter-hospital transfer. J Thorac Dis 2023; 15:2984-2996. [PMID: 37426131 PMCID: PMC10323583 DOI: 10.21037/jtd-22-1798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/24/2023] [Indexed: 07/11/2023]
Abstract
Background Early recognition of esophageal perforation may prevent morbidity and mortality, and accurate diagnostic imaging facilitates triage. Stable patients with suspected perforation may be transferred to higher levels of care before appropriate work-up and diagnosis confirmation. We reviewed patients transferred for esophageal perforation to critically analyze the diagnostic workflow. Methods We performed a retrospective review of patients transferred to our tertiary care institution from 2015-2021 for suspected esophageal perforation. Demographics, referring site characteristics, diagnostic studies, and management were analyzed. Bivariate comparisons were performed using Wilcoxon-Mann-Whitney tests for continuous variables and chi-squared or Fisher's exact tests for categorical variables. Results Sixty-five patients were included. Etiology of suspected perforation was spontaneous in 53.8% and iatrogenic in 33.8%. Most patients were transferred within 24 hours from time of suspected perforation (66.2%). Transferring sites included seven states and were 101-300 miles (32.3%) or >300 miles (26.2%) away. CT imaging was obtained in 96.9% before transfer, most commonly demonstrating pneumomediastinum (46.2%). Only 21.5% of patients had an esophagram before transfer. Following transfer, 36.9% (n=24) were ultimately not found to have esophageal perforation, demonstrated by negative arrival esophagram in 79.1%. In patients with confirmed perforation (n=41), 58.5% had surgery, 26.8% endoscopic intervention, and 14.6% supportive care. Conclusions After transfer a proportion of patients were ultimately found to not have esophageal perforation, typically demonstrated by negative esophagram upon arrival. We conclude that a recommendation of performing esophagram at the presenting site, when possible, may prevent unnecessary transfers, and will likely reduce costs, conserve resources, and decrease management delays.
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Affiliation(s)
- Helen J. Madsen
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christina M. Stuart
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brandon M. Wojcik
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Adam R. Dyas
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amanda Hunt
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Laura J. Helmkamp
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anna K. Gergen
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Simran K. Randhawa
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - John D. Mitchell
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert A. Meguid
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
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16
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Shahriarirad R, Karoobi M, Shekouhi R, Ebrahimi K, Ranjbar K, Amirian A, Mardani P, Fallahi MJ, Ziaian B. Esophageal perforation etiology, outcome, and the role of surgical management - an 18-year experience of surgical cases in a referral center. BMC Surg 2023; 23:177. [PMID: 37370071 DOI: 10.1186/s12893-023-02080-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Esophageal perforation is a surgical emergency with a high rate of morbidity and mortality. Its poor prognosis is mainly associated with previous patient-specific comorbidities and a lack of timely diagnosis and treatment. The objective of this study was to investigate the etiological factors and different surgical methods of treatment with consideration of mortality rate and comorbidities. METHOD The present cross-sectional study was conducted on patients who underwent surgical intervention due to esophageal injury from 2002 to 2019 (18 years). Demographic and clinical characteristics along with performed surgical interventions were evaluated accordingly. RESULTS In this study, 69 patients with a mean age of 38.8 years were evaluated, of which 45 (65.2%) cases were men. In terms of location of the perforation, the thoracic portion of the esophagus followed by the cervical and abdominal esophagus were more frequently injured with a rate of 32 (46.4%), 30 (43.5%), and 19 (27.5%) cases, respectively. Accordingly, foreign body ingestion followed by penetrating injuries were the most common causative agents leading to esophageal perforation. CONCLUSION Obtaining the desired results from the treatment of this condition depends on factors such as patients' previous comorbidities, cause of the rupture, the location of the esophageal damage, and delay in the start of treatment. Since there is no single gold standard treatment strategy, each patient should be individually evaluated.
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Affiliation(s)
- Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohamadreza Karoobi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Shekouhi
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamyar Ebrahimi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Keivan Ranjbar
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Amirian
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parviz Mardani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Javad Fallahi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bizhan Ziaian
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
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17
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Wei HX, Lv SY, Xia B, Zhang K, Pan CK. Bedside ultrasound-guided water injection assists endoscopically treatment in esophageal perforation caused by foreign bodies: A case report. World J Gastrointest Surg 2023; 15:1240-1246. [PMID: 37405102 PMCID: PMC10315116 DOI: 10.4240/wjgs.v15.i6.1240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/21/2023] [Accepted: 04/17/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Fishbone migration from the esophagus to the neck is relatively uncommon in clinical practice. Several complications secondary to esophageal perforation after ingestion of a fishbone have been described in the literature. Typically, a fishbone is detected and diagnosed by imaging examination and is usually removed by a neck incision.
CASE SUMMARY Herein, we report a case of a 76-year-old patient with a fishbone in the neck that had migrated from the esophagus and that was in close proximity to the common carotid artery, and the patient experienced dysphagia. An endoscopically-guided neck incision was made over the insertion point in the esophagus, but the surgery failed due to having a blurred image at the insertion site during the operation. After injection of normal saline laterally to the fishbone in the neck under ultrasound guidance, the purulent fluid outflowed to the piriform recess along the sinus tract. With endoscopic guidance, the position of the fish bone was precisely located along the direction of liquid outflow, the sinus tract was separated, and the fish bone was removed. To the best of our knowledge, this is the first case report describing bedside ultrasound-guided water injection positioning combined with endoscopy in the treatment of a cervical esophageal perforation with an abscess.
CONCLUSION In conclusion, the fishbone could be located by the water injection method under the guidance of ultrasound and could be accurately located along the outflow direction of the purulent fluid of the sinus by the endoscope and was removed by incising the sinus. This method can be a nonoperative treatment option for foreign body-induced esophageal perforation.
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Affiliation(s)
- Hua-Xing Wei
- Department of Ultrasound, The Fourth Affiliated Hospital of Zhejiang University College of Medicine, Yiwu 322200, Zhejiang Province, China
| | - Song-Yong Lv
- Department of Ultrasound, Jinyun County People’s Hospital, Lishui 321400, Zhejiang Province, China
| | - Bin Xia
- Department of Ultrasound, The Fourth Affiliated Hospital of Zhejiang University College of Medicine, Yiwu 322200, Zhejiang Province, China
| | - Kai Zhang
- Department of Ultrasound, The Fourth Affiliated Hospital of Zhejiang University College of Medicine, Yiwu 322200, Zhejiang Province, China
| | - Chen-Ke Pan
- Department of Ultrasound, The Fourth Affiliated Hospital of Zhejiang University College of Medicine, Yiwu 322200, Zhejiang Province, China
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18
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Tarazona MAD, Chaves CER, Mateus JFI, Comba FAR, Rosso JD, Uribe MCA. Boerhaave syndrome: Successful conservative treatment. Case report and literature review. Int J Surg Case Rep 2023; 107:108289. [PMID: 37187116 DOI: 10.1016/j.ijscr.2023.108289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/29/2023] [Accepted: 04/30/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Spontaneous esophageal perforation or "Boerhaave" syndrome is an uncommon pathology, with high rates of morbidity and mortality. Clinical scores such as the Pittsburgh classification could guide the treatment and helps to assess mortality risk. Conservative management could be performed in selected cases. CASE PRESENTATION We present a 19-year-old male patient with a previous history of anxiety and depression, who enters the emergency room with vomiting and epigastric pain followed by swelling at the neck and dysphagia. Neck tomography and chest tomography were obtained showing subcutaneous emphysema. Conservative management was indicated and after 10 days of in-hospital stay and no complications, the patient was discharged. Any complication was observed after 30, 60, and 90 days of follow-up. CLINICAL DISCUSSION Selected patients with Boerhaave syndrome could benefit from conservative management. Risk classification could be performed using the Pittsburgh score. Nil per os, antibiotic treatment, and nutritional support are the cornerstone of nonoperative management. CONCLUSION Boerhaave syndrome it's an infrequent pathology, with mortality rates ranging between 30 and 50 %. Early identification and on-time management are required to have favorable outcomes. Pittsburgh score can be used to guide the selection of patients who benefit from conservative treatment.
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Affiliation(s)
| | - Carlos Eduardo Rey Chaves
- Estudiante de posgrado Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Bogotá, Colombia.
| | - Juan Felipe Infante Mateus
- Estudiante de posgrado Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Bogotá, Colombia
| | | | - J D Rosso
- Cirujano General, Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Maria Camila Azula Uribe
- Cirujano General, Cirugía General, Pontificia Universidad Javeriana, Facultad de Medicina, Hospital Universitario San Ignacio, Bogotá, Colombia
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19
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Samidoust P, Ashoobi MT, Aghajanzadeh M, Delshad MSE, Haghighi M. Boerhaave's syndrome in a patient with achalasia: A rare case report. Int J Surg Case Rep 2023; 106:108183. [PMID: 37120898 PMCID: PMC10173186 DOI: 10.1016/j.ijscr.2023.108183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/18/2023] [Accepted: 03/21/2023] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Boerhaave's syndrome (BS) is a rare spontaneous perforation of the esophagus with a high rate of morbidity that results in death in the case of delayed diagnosis and treatment. Here, we describe a patient with achalasia who was diagnosed with BS. CASE PRESENTATION This present case is a 63-year-old man with a previous history of achalasia and with a complaint of sudden onset of severe right chest pain, epigastric pain, etc. to Razi hospital, Rasht, Iran in March 2022. CLINICAL DISCUSSION Due to the clinical findings of the patients, the diagnosis was BS and the patient's condition was reported to be good at the two-month follow-up. CONCLUSION Early diagnosis of BS results in more effective treatment. Also, stenting is suggested to be effective to reduce the rate of morbidity and mortality in patients with BS.
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Affiliation(s)
- Pirouz Samidoust
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Taghi Ashoobi
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Manouchehr Aghajanzadeh
- Inflammatory Lung Diseases Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran.
| | | | - Mohammad Haghighi
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
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20
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Yamana I, Fujikawa T, Kawamura Y, Hasegawa S. Current approach for Boerhaaves syndrome: A systematic review of case reports. World J Meta-Anal 2023; 11:112-124. [DOI: 10.13105/wjma.v11.i4.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/07/2023] [Accepted: 04/06/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND There is no consensus on the appropriate therapeutic strategy for Boerhaave syndrome due to its rarity and changing therapeutic approaches. We conducted a systematic review of case reports documenting Boerhaave syndrome.
AIM To assess the therapeutic methods and clinical outcomes and discuss the current trends in the management of Boerhaave syndrome.
METHODS We searched PubMed, Google scholar, MEDLINE, and The Cochrane Library for studies concerning Boerhaave syndrome published between 2017 and 2022.
RESULTS Of the included studies, 49 were case reports, including a total of 56 cases. The mean age was 55.8 ± 16 years old. Initial conservative treatment was performed in 25 cases, while operation was performed in 31 cases. The rate of conservative treatment was significantly higher than that of operation in cases of shock vital on admission (9.7% vs 44.0%; P = 0.005). Seventeen out of 25 conservative cases (68.0%) were initially treated endoscopic esophageal stenting; 2 of those 17 cases subsequently underwent operation due to poor infection control. Twelve cases developed postoperative leakage (38.7%), and 4 of those 12 cases underwent endoscopic esophageal stenting to stop the leakage. The length of the hospital stay was not significantly different between the conservative treatment and operation cases (operation vs conservation: 33.52 ± 22.69 vs 38.81 ± 35.28 days; P = 0.553).
CONCLUSION In the treatment of Boerhaave syndrome, it is most important to diagnose the issue immediately. Primary repair with reinforcement is the gold-standard procedure. The indication of endoscopic esophageal stenting or endoluminal vacuum-assisted therapy should always be considered for patients in a poor general condition and who continue to have leakage after repair.
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Affiliation(s)
- Ippei Yamana
- Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka 802-8555, Japan
| | - Takahisa Fujikawa
- Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka 802-8555, Japan
| | - Yuichiro Kawamura
- Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka 802-8555, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka 814-0180, Japan
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21
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Angelette AL, Rando LL, Wadhwa RD, Barras AA, Delacroix BM, Talbot NC, Ahmadzadeh S, Shekoohi S, Cornett EM, Kaye AM, Kaye AD. Tetracycline-, Doxycycline-, Minocycline-Induced Pseudotumor Cerebri and Esophageal Perforation. Adv Ther 2023; 40:1366-1378. [PMID: 36763302 DOI: 10.1007/s12325-023-02435-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023]
Abstract
Tetracyclines are a class of broad-spectrum bacteriostatic antibiotics used to treat many infections, including methicillin-resistant Staphylococcus aureus (MRSA), acne, pelvic inflammatory disease, chlamydial infections, and a host of zoonotic infections. These drugs work by inhibiting protein synthesis in bacterial ribosomes, specifically by disallowing aminoacyl-tRNA molecules from binding to the ribosomal acceptor sites. While rare, tetracycline antibiotics, particularly minocycline and doxycycline, are associated with an increased risk of developing esophageal perforation and pseudotumor cerebri (PTC, or idiopathic intracranial hypertension). Since tetracyclines are a commonly prescribed class of medications, especially in adolescents for acne treatment, it is important for clinicians to appreciate significant side effects that can result in morbidity and mortality. This paper aims to consolidate and to emphasize current research on the association between tetracycline antibiotics and the development of esophageal perforation, and PTC. PTC is a neurological syndrome consisting of increased intracranial pressure, headache, and vision changes without evidence of the contributing source, such as mass lesion, infection, stroke, or malignancy. Esophageal perforation, while rare, can be the result of pill esophagitis. Pill-induced injuries occur when caustic medicinal pills dissolve in the esophagus rather than in the stomach. Most patients experience only self-limited pain (retrosternal burning discomfort, heartburn, dysphagia, or odynophagia), but hemorrhage, stricture, and perforation may occur. Tetracycline use can lead to pill esophagitis. In summary, clinicians should appreciate the potential risks of tetracycline compounds in clinical practice.
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Affiliation(s)
- Alexis L Angelette
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Lauren L Rando
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Reena D Wadhwa
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Ashley A Barras
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Blake M Delacroix
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Norris C Talbot
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Adam M Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA, 95211, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
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22
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Adel MG, Sabagh VG, Sadeghimoghadam P, Albazal M. 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] [What about the content of this article? (0)] [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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Labadie M, Vaucel JA, Courtois A, Nisse P, Legeay M, Medernach C, Patat AM, Von Fabeck K, Gallart JC, Tournoud C, Puskarczyk E. Button Battery Ingestion in Children (PilBouTox®): A Prospective Study Describing the Clinical Course and Identifying Factors Related to Esophageal Impaction or Severe Cases. Dysphagia 2023; 38:446-456. [PMID: 35841456 DOI: 10.1007/s00455-022-10485-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/13/2022] [Indexed: 01/27/2023]
Abstract
In this study, we aimed to identify the factors related to esophageal impaction following button battery (BB) ingestion in children. PilBouTox, a prospective multicentric observational cohort study, was conducted from French Poison Control Centers between June 1, 2016 and May 31, 2018. Children (0-12 years old) with BB ingestion were included. After ingestion, patients were monitored for 21 days or more if they remained symptomatic (maximum 1 year). Causes of ingestion, clinical manifestations, medical management, and the outcomes were recorded. In total, 415 patients were included; among them, 35 had esophageal impaction and 14 had severe complications or died. Seven symptoms were closely related (relative risk (RR) > 30) to esophageal impaction: anorexia, drooling, dyspnea, fever, hemodynamic instability, pallor, and pain. Furthermore, BBs > 15 mm were related to esophageal impaction (RR = 19, CI95% [4.1; 88]). The absence of initial symptoms was a protective factor for esophageal impaction (RR = 0.013, CI95% [0.002; 0.1]). Nine symptoms were closely related (RR > 30) to major effects and death: dyspnea, cough, dysphagia, drooling, fever, hemodynamic instability, pain, pallor, and vomiting. Seven symptoms were related to esophageal impaction and their rapid recognition could help to ensure that the patient is taken to a health care facility. Nine factors were related to the major effects of BB ingestion. We recommended an X-ray as soon as possible to determine the position of the BB.Trial Registry: Clinical Trial ID: NCT03708250, https://clinicaltrials.gov/ct2/show/NCT03708250.
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Affiliation(s)
- Magali Labadie
- Centre Hospitalier et Universitaire de Bordeaux, Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], 1 Place Amélie Rabat Léon, 33000, Bordeaux, Aquitaine, France.
| | - Jules-Antoine Vaucel
- Centre Hospitalier et Universitaire de Bordeaux, Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], 1 Place Amélie Rabat Léon, 33000, Bordeaux, Aquitaine, France
| | - Arnaud Courtois
- Centre Hospitalier et Universitaire de Bordeaux, Centre Antipoison Nouvelle Aquitaine [Nouvelle Aquitaine Poison Control Center], 1 Place Amélie Rabat Léon, 33000, Bordeaux, Aquitaine, France
| | - Patrick Nisse
- Centre Antipoison [Lille Poison Control Center], Centre Hospitalier et Universitaire de Lille, 59000, Lille, France
| | - Marion Legeay
- Centre Antipoison [Angers Poison Control Center], Centre Hospitalier et Universitaire de Angers, 49000, Angers, Pays de la Loire, France
| | - Chantal Medernach
- Centre Antipoison de Paris [Paris Poison Control Center]-Fédération de Toxicologie, Groupe Hospitalier Lariboisière Fernand-Widal, 75000, Paris, Île-de-France, France
| | - Anne-Marie Patat
- Centre Antipoison [Lyon Poison Control Center], Centre Hospitalier et Universitaire de Lyon, 69000, Lyon, Auvergne-Rhône-Alpes, France
| | - Katharina Von Fabeck
- Centre Antipoison [Marseille Poison Control Center], Centre Hospitalier et Universitaire de Marseille, 13000, Marseille, France
| | - Jean-Christophe Gallart
- Centre Antipoison-SAMU 31 [Toulouse Poison Control Center], Centre Hospitalier et Universitaire de Toulouse, 31000, Toulouse, Midi-Pyrénées, France
| | | | - Christine Tournoud
- Centre Antipoison [East Poison Control Center], Centre Hospitalier et Universitaire de Nancy, 54000, Nancy, Lorraine, France
| | - Emmanuel Puskarczyk
- Centre Antipoison [East Poison Control Center], Centre Hospitalier et Universitaire de Nancy, 54000, Nancy, Lorraine, France
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24
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Niño-Ramírez S, Ardila O, Rodríguez FH, Londoño J, Pérez S, Sánchez S, Camargo J, Guevara-Casallas LG. Major adverse events related to endoscopic or laparoscopic procedures in achalasia. A systematic review and meta-analysis. Rev Gastroenterol Mex (Engl Ed) 2023; 88:36-43. [PMID: 34866041 DOI: 10.1016/j.rgmxen.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/02/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND AIMS Surgical or endoscopic treatments play an essential role in the management of achalasia. The probability of adverse events in the performance of said treatments is a relevant aspect, when establishing the risk-benefit balance. The present study aimed to establish the association between serious adverse events and the performance of those procedures, in adult patients with achalasia. MATERIALS AND METHODS A systemic search of randomized and nonrandomized clinical trials, retrospective cohorts, and cases series on adult patients with achalasia that underwent laparoscopic Heller myotomy (LHM), peroral endoscopic myotomy (POEM), or endoscopic balloon dilation, that reported serious adverse events, was carried out on the Medline, CENTRAL, and EBSCO databases. Serious adverse events were defined as: death at 30 days, Clavien-Dindo grade III or higher classification, esophageal or gastric perforation, pneumothorax, mucosal tear, leakage, emphysema, pneumonia, and chest pain. The methodology included the PRISMA guidelines for reporting systematic reviews. RESULTS Thirty-five studies were found that reported information on 1,276 patients that underwent POEM, 5,492 that underwent LHM, and 10,346 that underwent endoscopic balloon dilation. The proportions of adverse events for the three techniques were 3.6, 4.9, and 3.1%, respectively. DISCUSSION AND CONCLUSIONS The 3 therapeutic interventions evaluated had similar proportions of adverse events. There were few reports of death at 30 days as an outcome and the lack of standardization in reporting adverse events in the studies analyzed was prominent.
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Affiliation(s)
- S Niño-Ramírez
- Unidad de Gastroenterología, Clínica el Rosario, Medellín, Colombia.
| | - O Ardila
- Unidad de Gastroenterología, Clínica CES, Medellín, Colombia
| | - F H Rodríguez
- Unidad de Gastroenterología, Clínica CES, Medellín, Colombia
| | - J Londoño
- Facultad de Medicina, Universidad-Clínica CES, Medellín, Colombia
| | - S Pérez
- Facultad de Medicina, Universidad-Clínica CES, Medellín, Colombia
| | - S Sánchez
- Facultad de Medicina, Universidad-Clínica CES, Medellín, Colombia
| | - J Camargo
- Facultad de Medicina, Universidad-Clínica CES, Medellín, Colombia
| | - L G Guevara-Casallas
- Unidad de Gastroenterología, Clínica CES, Medellín, Colombia; Unidad de Gastroenterología, Clínica SOMER, Rionegro, Colombia
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25
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Kato T, Kazama Y, Matsuura S, Nagaoka S. Surgical treatment of esophageal perforation after stereotactic body radiotherapy: A report of two cases. Int J Surg Case Rep 2022; 102:107805. [PMID: 36502658 PMCID: PMC9758521 DOI: 10.1016/j.ijscr.2022.107805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/26/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Esophageal perforation due to stereotactic body radiotherapy (SBRT) is rare, and there is no consensus on the treatment strategy. Here, we report two cases of esophageal perforation caused by CyberKnife irradiation managed with distinct surgical approaches. CASE PRESENTATION Case 1 was a 54-year-old woman who was administered chemotherapy including bevacizumab and underwent CyberKnife SBRT for postoperative ovarian cancer (pStage IIIc) with metastasis in the eighth thoracic vertebra. Thirteen months after irradiation, she suddenly developed right back and anterior thoracic pain and was diagnosed with esophageal perforation. Despite open chest drainage and intercostal muscle (ICM) flap coverage, the fistula could not be closed, leading to pyogenic spondylitis and epidural abscess. Case 2 was of a 58-year-old woman with mediastinal lymph node metastasis 5 years after uterine cancer surgery (pStage Ia) who underwent CyberKnife SBRT. Six months after irradiation, she experienced back pain and was diagnosed with esophageal perforation. After curative esophagectomy, the patient was discharged on postoperative day 22 without any adverse effects. CLINICAL DISCUSSION Esophageal perforation by SBRT with vascular endothelial growth factor inhibitors (VEGFI) such as bevacizumab has rarely been reported. Considering the impaired wound healing system and blood perfusion caused by radiation therapy and VEGFI, difficulty closing the perforation covered with an ICM flap was hypothesized. CONCLUSION Late esophageal toxicity from irradiation may cause impaired blood flow and wound healing; therefore, curative esophagectomy, including at the perforation site, is effective.
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26
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Edholm D, Andersson RE, Frankel A. Esophageal perforations - a population-based nationwide study in Sweden with survival analysis. Scand J Gastroenterol 2022; 57:1018-1023. [PMID: 35400263 DOI: 10.1080/00365521.2022.2060051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Esophageal perforation is a rare and life-threatening condition with several treatment options. The aim was to assess the incidence, type of treatment and mortality of esophageal perforations in Sweden and to identify risk factors for 90-day mortality. METHOD All patients admitted with an esophageal perforation from 2007 to 2017 were identified from the National Patient Register. Mortality was assessed by linkage with the Cause of Death Registry. We analyze the incidence and the impact of age, sex, comorbidities on mortality. RESULTS 879 patients with esophageal perforation were identified, giving an incidence rate of 1.09 per 100,000 person-years. The median age at diagnosis was 68.8 years and 60% were men. The mortality was 26% at 90 days. Independent risk factors for death within 90 days were age (odds ratio (OR): 6.20; 95% (confidence interval) CI: 2.16-17.79 at 60-74 years and OR: 11.58; 95% CI: 4.04-33.15 at 75 years or older), peripheral vascular disease (OR: 2.92; 95% CI: 1.44-5.92) and underlying malignant disease (OR: 5.91; 95% CI: 3.86-9.03). In patients younger than 45 years, survival was lower among women than among men (at 5 years 73 and 93%, respectively). The cause of death among young women was often drug-related or suicide. CONCLUSIONS 90-day mortality was 26%, old age, vascular disease and underlying malignant disease were risk factors.
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Affiliation(s)
- David Edholm
- Department of Surgery, Linköping University, Linköping, Sweden.,Department Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Roland E Andersson
- Futurum, Academy for Health and Care, Jönköping County Council, Jönköping, Sweden
| | - Adam Frankel
- Discipline of Surgery, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
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27
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Andreatta E, Lovece A, Milani V, Asti E, Bonavina L. Does the Pittsburgh Severity Score Predict Patients' Outcomes in Benign Esophageal Perforations? J Gastrointest Surg 2022; 26:1757-1759. [PMID: 35229251 DOI: 10.1007/s11605-022-05281-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/19/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Erika Andreatta
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Andrea Lovece
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Valentina Milani
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
- IRCCS Policlinico San Donato, Piazza Malan 1, 20097 San Donato Milanese, Milan, Italy
| | - Emanuele Asti
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy.
- Department of Surgery, I.R.C.C.S. Policlinico San Donato, Piazza Malan 1, San Donato Milanese (Milano), 20097, Milan, Italy.
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28
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Li G, Wu D, Zhou L, You D, Huang X. Delayed Endoscopic Management of Esophageal Sharp-Pointed Food Impaction: An Analysis of 829 Cases in China. Dig Dis Sci 2022; 67:3166-76. [PMID: 34342753 DOI: 10.1007/s10620-021-07133-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/20/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Esophageal foreign body impaction is the most common cause of endoscopic emergency. However, there are limited available data on delayed endoscopic management of esophageal sharp-pointed food impaction. AIMS To investigate cases of esophageal sharp-pointed food impaction with endoscopic removal findings. METHODS This single-center retrospective study collected medical records to identify patients with esophageal sharp-pointed food impaction who underwent endoscopic removal between April 2018 and April 2020. The patients were divided into the early (endoscopic removal <12 h) and delayed intervention (>12 h) cohorts. RESULTS Overall, 133 and 696 patients received early and delayed intervention, respectively. The success rate of endoscopic foreign body removal was 96.45%. The most common foreign body was fish bone (66.90%), and the most common shape was "I" (56.26%). Patients from the delayed intervention cohort received general anesthesia with a higher risk for perforation, and no foreign body was identified. The duration of endoscopy, distance between the foreign body/wound and the incisor, and longest diameter of the foreign body were not different between the groups. In multivariate analysis, male sex (odds ratio = 1.792 [1.159, 2.771]; P = 0.009), longer duration of impaction (odds ratio = 2.212 [1.121, 4.365]; P = 0.022) and endoscopy (odds ratio = 1.502 [1.253, 1.800]; P < 0.001), and longest diameter of the foreign body (odds ratio = 1.632 [1.329, 2.003]; P < 0.001) were associated with a higher incidence of perforation in patients with foreign body impaction. CONCLUSIONS Endoscopic removal is a safe and effective treatment method for sharp-pointed food impaction. Delayed endoscopic removal can increase the risk of esophageal perforation.
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29
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Gratacós Gómez AR, Meneses Sotomayor JV, Joyanes Romo JB, Palacios Cañas A, Gonzalez Lopez L, Gomez Torrijos E. Symptoms and complications that require urgent treatment and upper digestive comorbidities in eosinophilic esophagitis. Dig Liver Dis 2022; 54:842-4. [PMID: 35418343 DOI: 10.1016/j.dld.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 12/12/2022]
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30
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Chen SL, Ho CY, Chin SC, Wang YC. Factors affecting perforation of the esophagus in patients with deep neck infection. BMC Infect Dis 2022; 22:501. [PMID: 35624431 PMCID: PMC9137079 DOI: 10.1186/s12879-022-07480-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background Deep neck infection (DNI) is a serious disease that can lead to severe morbidity, including esophageal perforation, and mortality. However, no previous study has explored the risk factors associated with esophageal perforation in patients with DNI. This study investigated these factors. Methods Between September 2015 and September 2021, 521 patients with DNI were studied. Relevant clinical variables and deep neck spaces were assessed. Results In a multivariate analysis, involvement of the retropharyngeal space (OR 5.449, 95% CI 1.603–18.51, p = 0.006) and the presence of mediastinitis (OR 218.8, 95% CI 55.98–855.3, p < 0.001) were independent risk factors associated with esophageal perforation in patients with DNI. There were no differences in pathogens between 32 patients with and 489 patients without esophageal perforation (all p > 0.05). Conclusion Involvement of the retropharyngeal space and the presence of mediastinitis were independent risk factors associated with esophageal perforation in patients with DNI. There were no differences in pathogens between the groups with and without esophageal perforation in DNI.
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Affiliation(s)
- Shih-Lung Chen
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. .,School of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Chia-Ying Ho
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shy-Chyi Chin
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Chien Wang
- Department of Otorhinolaryngology & Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology & Head and Neck Surgery, New Taipei Municipal TuCheng Hospital (Built and Operated By Chang Gung Medical Foundation), New Taipei, Taiwan
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31
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Gutschow CA, Schlag C, Vetter D. Endoscopic vacuum therapy in the upper gastrointestinal tract: when and how to use it. Langenbecks Arch Surg 2022; 407:957-964. [PMID: 35041047 PMCID: PMC9151563 DOI: 10.1007/s00423-022-02436-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Endoscopic vacuum therapy (EVT) has emerged as a novel treatment option for upper gastrointestinal wall defects. The basic principle of action of EVT entails evacuation of secretions, removal of wound debris, and containment of the defect. Furthermore, there is increasing evidence that EVT reduces interstitial edema, increases oxygen saturation, and promotes tissue granulation and microcirculation. Various devices, such as macroporous polyurethane sponge systems or open-pore film drains, have been developed for specific indications. Depending on the individual situation, EVT devices can be placed in- or outside the intestinal lumen, as a stand-alone procedure, or in combination with surgical, radiological, and other endoscopic interventions. PURPOSE The aim of this narrative review is to describe the current spectrum of EVT in the upper gastrointestinal tract and to assess and summarize the related scientific literature. CONCLUSIONS There is growing evidence that the efficacy of EVT for upper GI leakages exceeds that of other interventional treatment modalities such as self-expanding metal stents, clips, or simple drainages. Owing to the promising results and the excellent risk profile, EVT has become the therapy of choice for perforations and anastomotic leakages of the upper gastrointestinal tract in many centers of expertise. In addition, recent clinical research suggests that preemptive use of EVT after high-risk upper gastrointestinal resections may play an important role in reducing postoperative morbidity.
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Affiliation(s)
- Christian A Gutschow
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Christoph Schlag
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Diana Vetter
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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32
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Eroğlu A, Ulaş AB, Aydın Y. Is thoracic esophagostomy an option in esophageal perforation in pediatric patients? Turk Gogus Kalp Damar Cerrahisi Derg 2022; 30:294-298. [PMID: 36168568 PMCID: PMC9473600 DOI: 10.5606/tgkdc.dergisi.2022.20553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/15/2020] [Indexed: 06/16/2023]
Abstract
Esophagostomy and subsequent esophagectomy are extremely rare operations in the management of benign esophageal perforations in children. In this report, we present a 20-month-old female in whom we performed thoracic esophagostomy and subsequent intrathoracic esophagogastric anastomosis due to esophageal perforation caused by a chronic foreign body. The patient was discharged on the 10th postoperative day, and no complications were observed in the patient, who was followed for four years. The thoracic esophagostomy procedure helps preserve the esophageal length and easy execution of the esophagogastric anastomosis in the thorax. We believe it can be a safe and useful technique in carefully selected cases.
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Affiliation(s)
- Atilla Eroğlu
- Department of Thoracic Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Ali Bilal Ulaş
- Department of Thoracic Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
| | - Yener Aydın
- Department of Thoracic Surgery, Atatürk University Faculty of Medicine, Erzurum, Türkiye
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33
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Chen ZC, Chen GQ, Chen XC, Zheng CY, Cao WD, Deng GH. Endoscopic extraction of a submucosal esophageal foreign body piercing into the thoracic aorta: A case report. World J Clin Cases 2022; 10:2484-2490. [PMID: 35434050 PMCID: PMC8968600 DOI: 10.12998/wjcc.v10.i8.2484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/17/2021] [Accepted: 01/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Aorto-esophageal injury is a rare but life-threatening complication of esophageal foreign bodies, which typically requires open surgery. The best way to treat patients with this condition remains unclear. To date, few reports have described an aortic wall directly penetrated by a sharp foreign body. Here, we present a rare case of a fishbone completely embedded in the esophageal muscularis propria and directly piercing the aorta, which was successfully treated by endoscopy and thoracic endovascular aortic repair (TEVAR).
CASE SUMMARY We report the case of a 71-year-old man with a 1-d history of retrosternal pain after eating fish. No abnormal findings were observed by the emergency esophagoscopy. Computed tomography showed a fishbone that had completely pierced through the esophageal mucosa and into the aorta. The patient refused to undergo surgery for personal reasons and was discharged. Five days after the onset of illness, he was readmitted to our hospital. Endoscopy examination showed a nodule with a smooth surface in the middle of the esophagus. Endoscopic ultrasonography confirmed a fishbone under the nodule. After performing TEVAR, we incised the esophageal mucosa under an endoscope and successfully removed the fishbone. The patient has remained in good condition for 1 year.
CONCLUSION Incising the esophageal wall under endoscope and extracting a foreign body after TEVAR may be a feasible option for cases such as ours.
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Affiliation(s)
- Zhi-Cao Chen
- Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Gui-Quan Chen
- Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Xiao-Chun Chen
- Department of Gastroenterology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Chang-Ye Zheng
- Department of Radiology, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Wei-Dong Cao
- Department of Cardiovascular Surgery, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
| | - Gang-Hao Deng
- Department of Cardiovascular Surgery, Affiliated Dongguan Hospital, Southern Medical University, Dongguan 523000, Guangdong Province, China
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Sanz Segura P, Gotor Delso J, García Cámara P, Sierra Moros E, Val Pérez J, Soria Santeodoro MT, Uribarrena Amezaga R. Use of double-layered covered esophageal stents in post-surgical esophageal leaks and esophageal perforation: Our experience. Gastroenterología y Hepatología 2022; 45:198-203. [PMID: 34052404 DOI: 10.1016/j.gastrohep.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/02/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The use of esophageal stents for the endoscopic management of esophageal leaks and perforations has become a usual procedure. One of its limitations is its high migration rate. To solve this incovenience, the double-layered covered esophageal stents have become an option. OBJECTIVES To analyse our daily practice according to the usage of double-layered covered esophageal metal stents (DLCEMS) (Niti S™ DOUBLE™ Esophageal Metal Stent Model) among patients diagnosed of esophageal leak or perforation. METHODS Retrospective, descriptive and unicentric study, with inclusion of patients diagnosed of esophageal leak or perforation, from November 2010 until October 2018. The main aim is to evaluate the efficacy of DLCEMS, in terms of primary success and technical success. The secondary aim is to evaluate their (the DLCEMS) safety profile. RESULTS Thirty-one patients were firstly included. Among those, 8 were excluded due to mortality not related to the procedure. Following stent placement, technical success was reached in 100% of the cases, and primary success, in 75% (n=17). Among the complications, stent migration was present in 21.7% of the patients (n=5), in whom the incident was solved by endoscopic means. CONCLUSIONS According to our findings, DLCEMS represent an alternative for esophageal leak and perforation management, with a high success rate in leak and perforation resolutions and low complication rate, in contrast to the published data. The whole number of migrations were corrected by endoscopic replacement, without the need of a new stent or surgery.
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Affiliation(s)
- Patricia Sanz Segura
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - Jesús Gotor Delso
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Paula García Cámara
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Eva Sierra Moros
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
| | - José Val Pérez
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
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Wang LP, Zhou ZY, Huang XP, Bai YJ, Shi HX, Sheng D. Neck and mediastinal hematoma caused by a foreign body in the esophagus with diagnostic difficulties: A case report. World J Clin Cases 2022; 10:1961-1965. [PMID: 35317134 PMCID: PMC8891789 DOI: 10.12998/wjcc.v10.i6.1961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/16/2021] [Accepted: 01/12/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophageal foreign body (FB) is a common clinical emergency. Clinically, computed tomography (CT) scans are important in the diagnosis of FBs in the esophagus. Here, we report a case of esophageal perforation and cervical hematoma, caused by a FB, whose uniqueness made rapid diagnosis difficult.
CASE SUMMARY A 42-year-old man was transferred to our hospital with esophageal perforation, which was accompanied by cervical and mediastinal hematoma. CT scans only revealed a black shadow, approximately 2.5 cm in diameter, in the upper esophagus. After multidisciplinary discussion, he was quickly subjected to mediastinal hematoma resection, peripheral nerve compression release, esophageal FB removal and esophagectomy. Eventually, we removed a small crab with a pointed tip from his esophagus.
CONCLUSION This was an unusual case of occurrence of sharp polygonal esophageal FBs caused by a small crab. Rapid diagnosis of this FB was difficult, mainly due to its translucent nature. Occurrence of sharp FBs, with cavities that sometimes only appear as black shadows on CT scans, can easily be mistaken for esophageal lumens. More attention should be paid to such sharp polygonal FBs.
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Affiliation(s)
- Li-Ping Wang
- Department of Emergency and Trauma Center, The International Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Zhi-Ying Zhou
- Department of Emergency and Trauma Center, The International Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Xiao-Ping Huang
- Department of Emergency and Trauma Center, The International Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Yun-Juan Bai
- Department of Emergency and Trauma Center, The International Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Hai-Xia Shi
- Department of Emergency and Trauma Center, The International Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Di Sheng
- Department of Emergency and Trauma Center, The International Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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Willems S, Daemen JHT, Hulsewé KWE, Belgers EHJ, Sosef MN, Soufidi K, Vissers YLJ, de Loos ER. Outcomes after hybrid minimally invasive treatment of Boerhaave syndrome: a single-institution experience. Acta Chir Belg 2022:1-6. [PMID: 35020548 DOI: 10.1080/00015458.2022.2029035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Spontaneous esophageal perforation or Boerhaave syndrome is a life-threatening emergency, associated with significant morbidity and mortality. In this retrospective series we describe our single-center experience with a hybrid minimally invasive treatment approach for the treatment of Boerhaave syndrome. METHODS Clinical data of all patients who presented with spontaneous esophageal rupture between January 2009 and December 2019 were analyzed. All patients underwent esophageal endoscopic stenting to seal the perforation and debridement of the contaminated mediastinal and pleural cavity through video-assisted thoracoscopic surgery (VATS). Primary outcome measure was defined as in-hospital death and 30-day mortality. RESULTS Twelve patients were included with a median age of 63 years (interquartile range [IQR] 51-74 years) of whom 58% (n = 7) were male. The median Pittsburg perforation severity score was 6.5 (IQR 6-9). Endoscopic reintervention was required in 8 patients (67%), primarily due to stent dislocation. In addition, 5 patients (42%) required re-VATS due to empyema formation. Thirty-day mortality and in-hospital mortality were respectively 17% (n = 2) and 25% (n = 3). CONCLUSION Endoscopic stenting in combination with thoracoscopic debridement is an effective and safe minimally invasive hybrid approach for the treatment of Boerhaave syndrome. This is depicted by the relatively low mortality rates, even among patients with high perforation severity scores. The relatively low mortality rates may be attributed to the combined approach of rapidly sealing the defect and decontamination of the thorax. Future studies should aim to corroborate this evidence which is limited by its sample size and retrospective nature.
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Affiliation(s)
- Stefanie Willems
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Jean H. T. Daemen
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Karel W. E. Hulsewé
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Eric H. J. Belgers
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Meindert N. Sosef
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Khalida Soufidi
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Yvonne L. J. Vissers
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
| | - Erik R. de Loos
- Department of Surgery, Zuyderland Medical Center, Heerlen, Sittard, The Netherlands
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Reimer S, Seyfried F, Flemming S, Brand M, Weich A, Widder A, Plaßmeier L, Kraus P, Döring A, Hering I, Hankir MK, Meining A, Germer CT, Lock JF, Groneberg K. Evolution of endoscopic vacuum therapy for upper gastrointestinal leakage over a 10-year period: a quality improvement study. Surg Endosc 2022; 36:9169-9178. [PMID: 35852622 PMCID: PMC9652162 DOI: 10.1007/s00464-022-09400-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 06/19/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Endoscopic vacuum therapy (EVT) is an effective treatment option for leakage of the upper gastrointestinal (UGI) tract. The aim of this study was to evaluate the clinical impact of quality improvements in EVT management on patients' outcome. METHODS All patients treated by EVT at our center during 2012-2021 were divided into two consecutive and equal-sized cohorts (period 1 vs. period 2). Over time several quality improvement strategies were implemented including the earlier diagnosis and EVT treatment and technical optimization of endoscopy. The primary endpoint was defined as the composite score MTL30 (mortality, transfer, length-of-stay > 30 days). Secondary endpoints included EVT efficacy, complications, in-hospital mortality, length-of-stay (LOS) and nutrition status at discharge. RESULTS A total of 156 patients were analyzed. During the latter period the primary endpoint MTL30 decreased from 60.8 to 39.0% (P = .006). EVT efficacy increased from 80 to 91% (P = .049). Further, the need for additional procedures for leakage management decreased from 49.9 to 29.9% (P = .013) and reoperations became less frequent (38.0% vs.15.6%; P = .001). The duration of leakage therapy and LOS were shortened from 25 to 14 days (P = .003) and 38 days to 25 days (P = .006), respectively. Morbidity (as determined by the comprehensive complication index) decreased from 54.6 to 46.5 (P = .034). More patients could be discharged on oral nutrition (70.9% vs. 84.4%, P = .043). CONCLUSIONS Our experience confirms the efficacy of EVT for the successful management of UGI leakage. Our quality improvement analysis demonstrates significant changes in EVT management resulting in accelerated recovery, fewer complications and improved functional outcome.
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Affiliation(s)
- Stanislaus Reimer
- Department of Gastroenterology, University Hospital of Würzburg, Würzburg, Germany
| | - Florian Seyfried
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Würzburg, Würzburg, Germany.
| | - Sven Flemming
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Markus Brand
- Department of Gastroenterology, University Hospital of Würzburg, Würzburg, Germany
| | - Alexander Weich
- Department of Gastroenterology, University Hospital of Würzburg, Würzburg, Germany
| | - Anna Widder
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Lars Plaßmeier
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Peter Kraus
- Department of Gastroenterology, University Hospital of Würzburg, Würzburg, Germany
| | - Anna Döring
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Ilona Hering
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Mohammed K Hankir
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Alexander Meining
- Department of Gastroenterology, University Hospital of Würzburg, Würzburg, Germany
| | - Christoph-Thomas Germer
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Johan F Lock
- Department of General-, Visceral-, Transplant-, Vascular- and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Kaja Groneberg
- Department of Gastroenterology, University Hospital of Würzburg, Würzburg, Germany
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DeVivo A, Sheng AY, Koyfman A, Long B. High risk and low prevalence diseases: Esophageal perforation. Am J Emerg Med 2021; 53:29-36. [PMID: 34971919 DOI: 10.1016/j.ajem.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/23/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Esophageal perforation is a rare but serious condition associated with a high rate of morbidity and mortality. OBJECTIVE This article highlights the pearls and pitfalls of esophageal perforation, including diagnosis, initial resuscitation, and management in the emergency department based on current evidence. DISCUSSION Esophageal perforation occurs with injury to the layers of the esophagus, resulting in mediastinal contamination and sepsis. While aspects of the history and physical examination may prompt consideration of the diagnosis, the lack of classic signs and symptoms cannot be used to rule out esophageal perforation. Chest radiograph often exhibits indirect findings suggestive of esophageal perforation, but these are rarely diagnostic. Advanced imaging is necessary to make the diagnosis, evaluate the severity of the injury, and guide appropriate management. Management focuses on hemodynamic stabilization with intravenous fluids and vasopressors if needed, gastric decompression, broad-spectrum antibiotics, and a thoughtful approach to airway management. Proton pump inhibitors and antifungals may be used as adjunctive therapies. Current available evidence for various treatment options (conservative, endoscopic, and surgical interventions) for esophageal perforation and resulting patient outcomes are limited. A multidisciplinary team approach with input from thoracic surgery, interventional radiology, gastroenterology, and critical care is recommended, with admission to the intensive care setting. CONCLUSIONS An understanding of esophageal perforation can assist emergency physicians in diagnosing and managing this deadly disease.
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García-Moreno V, Maiocchi K, Gómez-Quiles L, Villarin-Rodríguez A, Aliaga-Hilario E, Martínez-Hernández A, Abdelkader N, López E, Escrig-Sos J, Laguna-Sastre JM. Treatment of esophageal perforation: A review of our experience at a tertiary referral hospital spanning the past 19 years. Rev Gastroenterol Mex (Engl Ed) 2021; 87:405-410. [PMID: 34887217 DOI: 10.1016/j.rgmxen.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 02/06/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION AND AIMS Esophageal perforation is an uncommon event that is a medical/surgical emergency, with a 15-30% mortality rate. The aim of the present study was to communicate our experience in the management of esophageal perforation, evaluating the different strategies utilized, in an effort to establish measures to guide decision-making in selecting treatment. MATERIALS AND METHODS A retrospective descriptive study was conducted on patients diagnosed with esophageal perforation at our hospital center, within the time frame of 2000 and 2019. RESULTS Over the past 19 years, 15 patients were diagnosed with esophageal perforation. Surgical treatment was carried out in 80% of the cases. Primary closure, reinforced with plasty, was performed in 67% of the patients, of whom 62.5% had early diagnosis and a 100% survival rate. Diagnosis was late in 37.5% of the cases, with a 33.3% survival rate. Esophagectomy and gastric pull-up were performed on 25% of the patients, 66.6% of whom had early diagnosis and a 100% survival rate. In the 33.3% that had late diagnosis, the mortality rate was 100%. Esophagectomy, with cervical esophagostomy and feeding jejunostomy, was performed on one of the patients (8.3%) that had early diagnosis and a 100% survival rate. CONCLUSIONS The main survival predictor in esophageal perforation is the interval of time between the injury and its diagnosis, and in turn, the resulting treatment. Each patient with esophageal perforation should have individualized treatment to adequately manage the condition.
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Affiliation(s)
- V García-Moreno
- Servicio de Cirugía General y del Aparato digestivo, Hospital General Universitario de Castellón, Castellón de la Plana, Spain.
| | - K Maiocchi
- Servicio de Cirugía General y del Aparato digestivo, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - L Gómez-Quiles
- Servicio de Cirugía General y del Aparato digestivo, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - A Villarin-Rodríguez
- Servicio de Cirugía General y del Aparato digestivo, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - E Aliaga-Hilario
- Servicio de Cirugía General y del Aparato digestivo, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - A Martínez-Hernández
- Servicio de Cirugía General y del Aparato digestivo, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - N Abdelkader
- Servicio de Cirugía General y del Aparato digestivo, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - E López
- Servicio de Cirugía General y del Aparato digestivo, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - J Escrig-Sos
- Servicio de Cirugía General y del Aparato digestivo, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - J M Laguna-Sastre
- Servicio de Cirugía General y del Aparato digestivo, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
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Ioannidis O, Malliora A, Christidis P, Kotidis E, Pramateftakis MG, Mantzoros I, Ouzounidis N, Foutsitzis V, Angelopoulos S, Tsalis K. Conservative treatment of Boerhaave's syndrome in an octogenarian complicated with late distal esophageal stenosis and successfully treated by stent placement. CIR CIR 2021; 89:23-27. [PMID: 34762618 DOI: 10.24875/ciru.20000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An 83-year-old female patient presented to the Emergency Department with shortness of breath, difficulty swallowing and left-sided chest pain following a vomiting attempt. A rupture in the left lower third of the esophagus, with hydropneumothorax, pneumomediastinum, and subcutaneous emphysema was revealed by chest X-ray, thoracic computed tomography scan, and contrast esophagography. The patient was successfully treated conservatively with closed thoracostomy, intravenous fluids, parenteral nutrition, and broad-spectrum antibiotics coverage. Following the successful conservative treatment, the patient developed a distal esophageal stenosis which was treated with an intra-esophageal self-expanding stent.
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Affiliation(s)
- Orestis Ioannidis
- Department of Surgery, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Malliora
- Department of Surgery, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Christidis
- Department of Surgery, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efstathios Kotidis
- Department of Surgery, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Manousos G Pramateftakis
- Department of Surgery, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Mantzoros
- Department of Surgery, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Ouzounidis
- Department of Surgery, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasilis Foutsitzis
- Department of Surgery, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stamatios Angelopoulos
- Department of Surgery, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Tsalis
- Department of Surgery, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Abstract
Background Boerhaave’s syndrome is the spontaneous rupture of the esophagus, which requires early diagnosis and treatment. Symptoms may vary, and diagnosis can be challenging. Case presentation Case 1: A 54-year-old Chinese man presented to us with sudden-onset epigastric pain radiating to the back following hematemesis. Upper gastrointestinal endoscopy revealed a full-thickness rupture of the esophageal wall. Subsequent computed tomography showed frank pneumomediastinum and heterogeneous pleural effusion. Immediately, esophageal perforation repair operation and jejunostomy were performed. The postoperative period was uneventful, and he was discharged. Case 2: A 62-year-old Chinese man was admitted to the emergency department with thoracic dull pain and chest distress. Chest computed tomography scan showed pneumomediastinum and large left-sided pleural effusion. Esophagus fistula was confirmed by contrast esophagography. Then, we performed thoracotomy to repair the esophageal tear as well as to debride and irrigate the left pleural space. His postoperative period was uneventful, with no leakage or stricture. Case 3: The patient was a 69-year-old Chinese male presenting with severe retrosternal and upper abdominal pain following an episode of forceful vomiting. Thoracic computed tomography scan revealed a rupture in the left distal part of the esophagus, a pneumomediastinum, and left-sided pleural effusions. Conservative treatment failed to improve disease conditions. Open thoracic surgery was performed with debridement and drainage of the mediastinum and the pleural cavity, after which he made a slow but full recovery. Conclusions We highlight that early diagnosis and appropriate surgical treatment are essential for optimum outcome in patients with esophageal rupture. We emphasize the importance of critical care support, particularly in the early stages of management.
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Affiliation(s)
- Jiayue Wang
- Department of Obstetrics and Gynecology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang Province, China
| | - Degang Wang
- Department of Thoracic Surgery, Chaoyang Municipal Central Hospital, Chaoyang, Liaoning Province, China
| | - Jianjiao Chen
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Chon SH, Töx U, Lorenz F, Rieck I, Wagner BJ, Kleinert R, Fuchs HF, Goeser T, Quaas A, Bruns CJ. A Novel Hybrid Stent with Endoscopic Vacuum Therapy for Treating Leaks of the Upper Gastrointestinal Tract. Visc Med 2021; 37:403-409. [PMID: 34722723 DOI: 10.1159/000512320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Self-expanding metal stents (SEMS) are an established option for treating leaks in the upper gastrointestinal tract, and endoscopic vacuum therapy (EVT) has become a promising alternative. A novel approach is the use of an esophageal hybrid SEMS (VACStent®), which can maintain esophageal passage during EVT. We present the first study demonstrating successful use of the VACStent® for treating leaks of the upper gastrointestinal tract. Method We performed a retrospective, single-center study of all patients who underwent endoscopic stenting with the VACStent® of leaks in the upper gastrointestinal tract. Results Indications for treatment with the VACStent® were: iatrogenic esophageal perforation (n = 1), spontaneous perforation (n = 2), esophageal fistula (n = 2), and anastomotic leak after upper gastrointestinal surgery (n = 5). Successful application of the VACStent® was achieved in all patients (n = 10; 100%) with a total of 15 interventions. VACStent® therapy was used as a first-line treatment in 5 patient (success rate 80%; 4 out 5 patients) and as a second-line treatment after failed previous endoscopic therapy in 5 patients (success rate 60%; 3 out of 5 patients). Overall, VACStent® treatment was successful in 70% of the patients (7 out of 10). No severe VACStent® treatment-related adverse events occurred. Conclusion The initial experience has been that the technical application of the VACStent® is safe and technically feasible. However, due to the small number of patients this study could not show the clear advantages of this novel hybrid stent. More studies are necessary to show significant advantages.
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Affiliation(s)
- Seung-Hun Chon
- Department of General, Visceral, Cancer, and Transplant Surgery, University Hospital Cologne, Cologne, Germany
| | - Ulrich Töx
- Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
| | - Florian Lorenz
- Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
| | - Isabel Rieck
- Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
| | | | - Robert Kleinert
- Department of General, Visceral, Cancer, and Transplant Surgery, University Hospital Cologne, Cologne, Germany
| | - Hans Friedrich Fuchs
- Department of General, Visceral, Cancer, and Transplant Surgery, University Hospital Cologne, Cologne, Germany
| | - Tobias Goeser
- Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
| | - Alexander Quaas
- Department of Pathology, University Hospital Cologne, Cologne, Germany
| | - Christiane J Bruns
- Department of General, Visceral, Cancer, and Transplant Surgery, University Hospital Cologne, Cologne, Germany
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Parihar PS, Singhal P, Singh A, Singh A, Sehra R, Farooq A, Singh AP, Mathur P. Spontaneous Esophageal Perforation in an Infant: A Rare Case. Indian J Otolaryngol Head Neck Surg 2021; 73:514-518. [PMID: 34692464 DOI: 10.1007/s12070-020-01993-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022] Open
Abstract
Spontaneous perforation of the esophagus is an emergency that requires early diagnosis and management. It may be fatal and delay in treatment can cause an increase in morbidity and mortality. Despite of being very rare in infants, we have to be watchful whenever we encounter signs and symptoms related to it. Only 7 cases of spontaneous esophageal perforation in infants have been report in the literature to the best of our knowledge. Here we are reporting a rare case of spontaneous esophageal rupture in an infant.
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Affiliation(s)
- Punit Singh Parihar
- Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan India
| | - Pawan Singhal
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, Rajasthan India
| | - Ankit Singh
- Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan India
| | - Amreen Singh
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, Rajasthan India
| | - Ritu Sehra
- Department of Otorhinolaryngology, SMS Medical College, Jaipur, Rajasthan India
| | - Aadil Farooq
- Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan India
| | - Aditya Pratap Singh
- Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan India
| | - Praveen Mathur
- Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan India
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Wang DQ, Liu M, Fan WJ. Secondary aortoesophageal fistula initially presented with empyema after thoracic aortic stent grafting: A case report. World J Clin Cases 2021; 9:8938-8945. [PMID: 34734078 PMCID: PMC8546808 DOI: 10.12998/wjcc.v9.i29.8938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/07/2021] [Accepted: 09/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Massive upper gastrointestinal (GI) bleeding is usually urgent and severe, and is mostly caused by GI diseases. Aortoesophageal fistula (AEF) after thoracic aortic stent grafting is a rare cause of this condition, and has a poor prognosis with a high mortality rate. The clinical symptoms of AEF are usually nonspecific, and the diagnosis is often difficult, especially when upper GI bleeding is absent. Early identification, early diagnosis, and early treatment are very important for improving prognosis.
CASE SUMMARY A 74-year-old man was admitted to the infectious disease department with > 10-d fever and 10-mo prior history of thoracic aortic stent grafting for thoracic aortic penetrating ulcers. Blood tests revealed elevated inflammatory indicators and anemia. Chest computed tomography (CT) showed postoperative changes of the aorta after endovascular stent graft implantation, pulmonary infection and pleural effusion. Pleural effusion tests showed empyema. After 1 wk of anti-infective treatment, temperature returned to normal and chest CT indicated improvement in pulmonary infection and reduction of pleural effusion. Esophageal endoscopy was performed because of epigastric discomfort, and showed a large ulcer with blood clot in the middle esophagus. However, on day 11, hematemesis and melena developed suddenly. Bleeding stopped temporarily after hemostatic treatment and bedside endoscopic hemostasis. Thoracic and abdominal aortic CT angiography confirmed AEF. Later that day, he suffered massive hemorrhage and hemorrhagic shock. Eventually, his family elected to discontinue treatment.
CONCLUSION AEF should be strongly considered in patients with a history of aortic intervention who present with fever, especially with empyema.
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Affiliation(s)
- De-Qiong Wang
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Mei Liu
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Wen-Juan Fan
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Shennib H, Baribault M, Heuser R. Bovine xenograft pericardial patch use for definitive single stage repair of a large esophageal defect: a case report. J Cardiothorac Surg 2021; 16:300. [PMID: 34645503 PMCID: PMC8515757 DOI: 10.1186/s13019-021-01670-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background Large esophageal perforations are challenging and often treated with exclusion or resection. This case demonstrates the feasibility of definitive surgical repair of a large esophageal perforation using large bovine pericardial patch. Case A patient with missed Boerhaave Syndrome underwent transesophageal echocardiography causing worsening perforation and sepsis. At thoracotomy and faced with a large esophageal defect, a large Bovine pericardial patch was used for repair with omentopexy. The patient recovered promptly and at 8 months was asymptomatic with satisfactory studies. Conclusion Xenograft pericardium is available and widely used for vascular reconstructions. It’s use for primary repair of large esophageal perforations should be considered.
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Affiliation(s)
- Hani Shennib
- Department of Surgery, College of Medicine, University of Arizona, 6122 33rd St, Paradise Valley, Phoenix, AZ, 85253, USA.
| | - Michelle Baribault
- Department of Surgery, College of Medicine, University of Arizona, 6122 33rd St, Paradise Valley, Phoenix, AZ, 85253, USA
| | - Richard Heuser
- Department of Surgery, College of Medicine, University of Arizona, 6122 33rd St, Paradise Valley, Phoenix, AZ, 85253, USA
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Kim JD. Prognostic factors of esophageal perforation and rupture leading to mortality: a retrospective study. J Cardiothorac Surg 2021; 16:291. [PMID: 34627308 PMCID: PMC8502388 DOI: 10.1186/s13019-021-01680-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/29/2021] [Indexed: 12/05/2022] Open
Abstract
Background Esophageal perforation and rupture (EPR) is a serious, potentially life-threatening condition. However, no treatment methods have been established, and data concerning factors affecting mortality are limited. This report presents the prognostic factors of mortality in EPR based on experience in the management of such patients. Methods For this retrospective analysis, 79 patients diagnosed as having EPR between 2006 and 2016 and managed at Gyeongsang National University Hospital were examined. The management method was determined in accordance with the location and size of the EPR, laboratory findings, and radiological findings. Thirty-nine patients were treated with surgery; and 40, with nonsurgical management. Results The most common cause of EPR was foreign body (fish bone or meat bone), followed by vomiting, iatrogenic causes, and trauma. Thirty-nine patients underwent primary repair of EPR, of whom 4 patients died. Forty patients underwent nonsurgical management, of whom 3 patients died. The remaining patients were discharged. Mortality correlated with the size of the EPR (> 25 mm) and the segmented neutrophil count percentage (> 86.5%) in the white blood cell test and differential. Conclusions The mortality risk was increased when the EPR size and the segmented neutrophil count percentage in the white blood cell test and differential was high. Delayed diagnosis, which was considered an important predictive factor in previous investigations, was not statistically significant in this study. Trial registration: Not applicable.
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Affiliation(s)
- Jong Duk Kim
- Department of Cardiothoracic Surgery, School of Medicine, Gyeonsang National University, Gyeongsang National University Hospital, Jin-Ju, 79 Gangnam-ro, Jinju-si, Gyeongsangnam-do, 52727, Republic of Korea.
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Kay HG, Campbell B, Gallant JN, Carlile C, Wright P, Stephens B, Rohde SL. Delayed Upper Aerodigestive Tract Perforation from Anterior Cervical Spine Hardware: Treatment and Swallowing Outcomes. Dysphagia 2021; 37:988-994. [PMID: 34510250 DOI: 10.1007/s00455-021-10361-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022]
Abstract
Delayed upper aerodigestive tract (UADT) perforation is a rare complication of anterior cervical spinal hardware. The purpose of this study was to investigate swallowing outcomes between treatment approaches for delayed UADT perforation. A retrospective chart review was performed on patients with anterior cervical hardware and delayed UADT perforation who were treated at a single tertiary care center between 2000 and 2020. Of the twelve patients identified, most patients presented with dysphagia (n = 9, 75%) and/or neck pain (n = 7, 58%). Perforations generally occurred at the level of C6 (n = 6, 50%) and C7 (n = 4, 33%) and spanned only one spinal level (n = 8, 67%). The majority (n = 8, 67%) of patients were past or current cigarette users. Operative approaches included primary repair (n = 5, 42%) and rotational flap (n = 4, 33%); the rotational flap harvest sites included supraclavicular fasciocutaneous (n = 2), infrahyoid muscle (n = 1), and sternocleidomastoid muscle (n = 1). While most patients demonstrated penetration and/or aspiration on first post-operative swallow study (n = 6), this resolved completely within a median time of 31 days. There were no differences in swallowing outcomes between repair approaches. Patient smoking history appears to be a clear risk factor for the development of delayed UADT perforation from anterior cervical spine hardware. A variety of techniques can be used to repair these perforations, and there were no differences in swallowing outcomes between repair approaches.
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Affiliation(s)
- Hannah G Kay
- School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin Campbell
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jean-Nicolas Gallant
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Catherine Carlile
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Patty Wright
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Byron Stephens
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah L Rohde
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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Sharma A, Shabani S, Khan M, Padhya T, Mifsud M. Algorithmic Approach to Reconstruction of Esophageal/Hypopharyngeal Injuries After Anterior Cervical Spinal Fusion. World Neurosurg 2021; 155:e655-64. [PMID: 34478891 DOI: 10.1016/j.wneu.2021.08.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Anterior cervical disk fusion (ACDF) is a common surgical approach for the treatment of cervical spine pathology. Esophageal perforations, though uncommon, are a devastating complication of this surgery. The objective of this paper is to assess the success of different treatment approaches for the management of esophageal/pharyngeal injury after ACDF. METHODS Given the absence of prospective trials, the review includes institutional case reports and case series from 1985-2020 in the English language literature. Only cases of esophageal/pharyngeal injury in the setting of anterior cervical hardware were considered for study inclusion. For purposes of this study, treatment success is defined as resumption of oral intake. RESULTS The database review identified 76 distinct series that meet criteria for study inclusion, with 173 patients available for analysis. A heterogeneous array of treatments was used for the management of pharyngoesophageal injuries after ACDF ranging from observation to complex free tissue reconstruction, with varying degrees of treatment success reported. We identified a number of factors, specifically duration of injury from initial ACDF procedure, which may impact the complexity of treatment required to maximize likelihood of treatment success. CONCLUSIONS Pharyngoesophageal injuries, albeit rare, are a serious and often complex complication after ACDF procedures. We propose a detailed algorithmic approach to guide decision making if faced with this clinical challenge. The huge variability in how these patients are treated emphasizes the potential utility of future multiinstitutional studies.
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Jung CFM, Müller-Dornieden A, Gaedcke J, Kunsch S, Gromski MA, Biggemann L, Seif Amir Hosseini A, Ghadimi M, Ellenrieder V, Wedi E. Impact of Endoscopic Vacuum Therapy with Low Negative Pressure for Esophageal Perforations and Postoperative Anastomotic Esophageal Leaks. Digestion 2021; 102:469-479. [PMID: 32045916 DOI: 10.1159/000506101] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/20/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Management of esophageal anastomotic leaks (AL) and esophageal perforations (EP) remains difficult and often requires an interdisciplinary treatment modality. For primary endoscopic management, self-expanding metallic stent (SEMS) placement is often considered first-line therapy. Recently, endoscopic vacuum therapy (EVT) has emerged as an alternative or adjunct for management of these conditions. So far, data for EVT in the upper gastrointestinal-tract is restricted to single centre, non-randomized trials. No studies on optimal negative pressure application during EVT exist. The aim of our study is to describe our centre's experience with low negative pressure (LNP) EVT for these indications over the past 5-years. PATIENTS AND METHODS Between January 2014 and December 2018, 30 patients were endoscopically treated for AL (n = 23) or EP (n = 7). All patients were primarily treated with EVT and LNP between -20 and -50 mm Hg. Additional endoscopic treatment was added when EVT failed. Procedural and peri-procedural data, as well as clinical outcomes including morbidity and mortality, were analysed. RESULTS Clinical successful endoscopic treatment of EP and AL was achieved in 83.3% (n = 25/30), with 73.3% success using EVT alone (n = 22/30). Mean treatment duration until leak closure was 16.1 days (range 2-58 days). Additional treatment modalities for complete leak resolution was necessary in 10% (n = 3/30), including SEMS placement and fibrin glue injection. Mean hospital stay for patients with EP was shorter with 33.7 days compared to AL with 54.4 days (p = 0.08). Estimated preoperative 10-year overall survival (Charlson comorbidity score) was 39.4% in patients with AL and 59.9% in patients with EP (p = 0.26). A mean of 5.1 EVT changes (range 1-12) was needed in EP and 3.6 changes (range 1-13) in AL to achieve complete closure, switch to other treatment modality, or reach endoscopic failure (p = 0.38). CONCLUSION LNP EVT enables effective minimally - invasive endoluminal leak closure from anastomotic esophageal leaks and EP in high-morbid patients. In this study, EVT was combined with other endoscopic treatment options such as SEMS placement or fibrin glue injection in order to achieve leak or perforation closure in the vast majority of patients (83.3%). Low aspiration pressures led to slower but still sufficient clinical results.
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Affiliation(s)
- Carlo Felix Maria Jung
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Annegret Müller-Dornieden
- Department of General-, Visceral- and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Jochen Gaedcke
- Department of General-, Visceral- and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Steffen Kunsch
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Mark A Gromski
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lorenz Biggemann
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Ali Seif Amir Hosseini
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Michael Ghadimi
- Department of General-, Visceral- and Pediatric Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Volker Ellenrieder
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Edris Wedi
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Göttingen, Göttingen, Germany,
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Varona Porres D, Persiva O, Sánchez AL, Cabanzo L, Pallisa E, Andreu J. Finding the bubble: atypical and unusual extrapulmonary air in the chest. Radiologia (Engl Ed) 2021; 63:358-369. [PMID: 34246426 DOI: 10.1016/j.rxeng.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/03/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the diagnosis in managing these patients. CONCLUSION In this article, we review a series of cases collected at our center that manifest with extrapulmonary air in the thorax, paying special attention to atypical and uncommon causes. We discuss the causes of extrapulmonary according to its location: mediastinum (spontaneous pneumomediastinum with pneumorrhachis, tracheal rupture, dehiscence of the bronchial anastomosis after lung transplantation, intramucosal esophageal dissection, Boerhaave syndrome, tracheoesophageal fistula in patients with esophageal tumors, bronchial perforation and esophagorespiratory fistula due to lymph-node rupture, and acute mediastinitis), pericardium (pneumopericardium in patients with lung tumors), cardiovascular (venous air embolism), pleura (bronchopleural fistulas, spontaneous pneumothorax in patients with malignant pleural mesotheliomas and primary lung tumors, and bilateral pneumothorax after unilateral lung biopsy), and thoracic wall (infections, transdiaphragmatic intercostal hernia, and subcutaneous emphysema after lung biopsy).
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Affiliation(s)
- D Varona Porres
- Servicio de Radiodiagnóstico, Hospital Vall de Hebron, Barcelona, Spain.
| | - O Persiva
- Servicio de Radiodiagnóstico, Hospital Vall de Hebron, Barcelona, Spain
| | - A L Sánchez
- Servicio de Radiodiagnóstico, Hospital Vall de Hebron, Barcelona, Spain
| | - L Cabanzo
- Servicio de Radiodiagnóstico, Hospital Vall de Hebron, Barcelona, Spain
| | - E Pallisa
- Servicio de Radiodiagnóstico, Hospital Vall de Hebron, Barcelona, Spain
| | - J Andreu
- Servicio de Radiodiagnóstico, Hospital Vall de Hebron, Barcelona, Spain
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