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PubMed1992

Isolation of Legionella pneumophila serogroup 5 from empyema following esophageal perforation. Source of the organism and mode of transmission.

A patient undergoing esophageal dilatation for carcinoma of the esophagus suffered esophageal perforation and development of an empyema. Culture of pleural fluid yielded multiple organisms, including Legionella pneumophila serogroup 5. Epidemiologic investigation showed that the source of L pneumophila was a tap used by the nursing personnel to fill patients' water pitchers. Whole-cell restriction endonuclease analysis of DNA from the clinical and environmental isolates of L pneumophila serogroup 5 yielded identical patterns. Our findings suggest that L pneumophila was acquired by the patient at least 12 h prior to the procedure causing the esophageal perforation and empyema, suggesting that the organism can persist in an infectious form in the upper aerodigestive tract.

Aged↗
PubMed2005

Fatal esophageal perforation caused by invasive candidiasis.

Instrumental lesions, spontaneous rupture, and trauma cause most esophageal perforations. Transmural fungal infection is extremely rare, although Candida may be detected in as many as 25% of normal esophagus. In this report we present a case of fatal esophageal perforation due to transmural Candida infection in a 76-year-old woman. The patient died from septic shock and multiorgan failure, despite esophageal resection and systemic antifungal therapy. Pathogenetic aspects and treatment strategies are discussed.

Aged↗
PubMed1991

Esophageal perforation during surgery on the cervical spine.

Esophageal perforation during surgery for cervical disc herniation is a rare complication. Differences in the time of diagnosis of this complication in three patients--no delay and delays of 6 hours and 4 days, respectively--resulted in different symptoms and outcomes. Early detection of the perforation allows prompt treatment. In the early stage, primary suture and, if necessary, interposition of vital tissue are sufficient to complete healing. In later stages, only drainage procedures, sometimes with a diversion of the salivary leakage, are indicated. In the reported patients, the outcome was favorable. On the other hand as an ongoing infection may cause mediastinitis, awareness of this complication and urgent surgical treatment may be lifesaving.

Adult↗
PubMed1976

Surgical treatment of late esophageal perforations.

The salvage of patients with late esophageal perforations is a formidable surgical undertaking. The basic objectives of surgical therapy should be: prompt debridement and control of sepsis by establishing an adequate, controlled route of decompression drainage, salvage of all viable and functional esophagus (except in massive disruptions with circumferential loss), adequate support of life control systems, and establishment of an appropriate alternate route for supportive alimentation. The method of treatment used in the group of patients reported here satisfies all these objectives. Our experience justifies further consideration of this technique in dealing with this catastrophic illness.

Adult↗
PubMed1999

Treatment of endoscopic esophageal perforation.

BACKGROUND: The increasing usage of flexible endoscopy leads to a higher incidence of esophageal perforations, whose treatment strategies (conservative or operative) still are discussed controversially. We present our experiences and therapy concepts in relation to 75 iatrogenic esophageal perforations. PATIENTS: Between 1983 and 1997, 75 patients were treated for endoscopic perforation of the esophagus. The gender distribution was 31 females (41.3%) and 44 males (58.7%), with a mean age of 64.4 years (range 2-90 years). RESULTS: Therapeutic endoscopy was the most common cause of perforation (73 of 75 patients; 97.3%). Diagnostic endoscopy caused perforation in 2 patients (2.7%). The perforation was located in the cervical part of the esophagus in 7 patients (9.3%), the intrathoracic part in 25 patients (33.3%), and the abdominal part in 43 patients (57.3%). In this study population, 25 patients (33.3%) were treated surgically, and 50 patients (66.7%) conservatively. The overall in-hospital mortality rate was 14 of 75 patients (18.7%). In the surgically treated group the rate was 6 of 25 patients (24%) and in the conservative group 8 of 50 patients (16%). CONCLUSIONS: The decision of a treatment strategy depends on different factors such as the location and extent of the injury, the time interval between perforation and treatment onset, the preexisting diseases, and the patient's general condition. In view of these factors, an individual therapy concept should be determined for every patient.

Adolescent↗
PubMed1997

Esophageal perforation: comparison of use of aqueous and barium-containing contrast media.

PURPOSE: To assess the need for follow-up esophagography with barium-containing contrast medium after examination with a water-soluble contrast medium in the detection of esophageal perforation. MATERIALS AND METHODS: Sixty-seven patients suspected of having esophageal perforation were examined prospectively with use of an aqueous contrast medium during a 1-year period. The examinations were performed with a digital fluoroscopy unit. Eighteen patients without proved extravasation at esophagography performed with aqueous contrast medium and without other contraindications underwent esophagography with barium-containing contrast medium. RESULTS: In four of 18 patients (22%) with unremarkable findings at esophagography performed with a water-soluble contrast medium, a perforation was detected subsequently with use of a barium-containing contrast medium. No complications related to barium extravasation occurred. CONCLUSION: Patients suspected of having esophageal perforation and who have unremarkable findings at esophagography with water-soluble contrast media need to undergo follow-up esophagography with a barium-containing contrast medium. The use of a digital fluoroscopy unit does not obviate the follow-up examination.

Adult↗
PubMedDate not supplied

Esophageal perforation--associated risk with balloon tamponade after endoscopic therapy. Myth or reality?

BACKGROUND/AIMS: Variceal bleeding is still associated with high mortality and balloon tamponade may be a lifesaving measure when endoscopic therapy is not available or feasible. The risk of esophageal perforation with balloon tamponade after endoscopic therapy is still uncertain. The aims of the study were to investigate balloon tamponade effectiveness and safety after endoscopic therapy. METHODOLOGY: Retrospective analysis of 100 consecutive episodes of acute variceal bleeding treated with the Sengstaken-Blakemore tube. RESULTS: Balloon tamponade had an overall effectiveness of 61%. The Child-Pugh score was significantly higher in patients who failed balloon tamponade. In 48 cases balloon tamponade was preceded by failure of endoscopic therapy. Balloon tamponade was more effective if a previous attempt to perform endoscopic therapy happened (75% vs. 48%; p = 0.006). Aspiration was the most frequent complication. No cases of esophageal perforation were registered. CONCLUSIONS: Currently balloon tamponade is only used as a temporary bridge to other strategies, when other forms of hemostatic therapies do not succeed. Balloon tamponade was more effective in patients with less severe hepatic dysfunction. Previous attempts to perform endoscopic therapy may augment tamponade effectiveness without increasing the risk of esophageal perforation.

Adult↗
PubMed2001

Cervical esophageal perforation during EUS: a national survey.

BACKGROUND: EUS is considered to be as safe a procedure as EGD. However, the longer, rigid tip of the echoendoscopes raises concern about cervical esophageal perforation during intubation. Our aim was to determine the rate of this complication. METHODS: Members of the American Endosonography Club were surveyed by questionnaire to determine the number of EUS examinations performed and the number of cervical esophageal perforations encountered up to June 1999. Each questionnaire was coded to avoid duplicate reporting. RESULTS: Questionnaires were mailed to 203 members; 86 (42.4%) responded. Cervical esophageal perforation occurred in 16 of 43,852 reported upper EUS procedures at a frequency of 0.03%. Fifteen (94%) patients were elderly. A history of difficult intubation with prior endoscopic procedures was present in 7 (44%) patients. Three patients had large cervical osteophytes. In 9 (56%) patients, the procedure was done by an endosonographer with less than 1 year of experience. Two patients required surgery. One patient died as a result of the perforation and the other 13 (81%) patients were managed successfully with conservative treatment. CONCLUSIONS: The incidence of cervical perforation during upper EUS may be higher than during EGD. Advanced patient age, difficult intubation during prior upper endoscopy, operator inexperience, and the presence of large cervical osteophytes may contribute to cervical perforation during upper EUS examination.

Aged↗
PubMed2003

Delayed diagnosis of esophageal perforation following intraoperative transesophageal echocardiography during valvular replacement--a case report.

A 62 year-old man sustained esophageal perforation following intra-operative transesophageal echocardiography (TEE) in a valvular replacement surgery. Septic shock developed on the 12th postoperative day (POD) and the esophageal perforation was diagnosed with chest CT. Emergent operation together with intensive care saved the patient's life. We speculate that the mechanism of perforation was not due to manipulation of the probe, but rather due to ischemia of the esophagus resulting from the combination of probe compression, non-pulsatile flow and the distension of the atria during a lengthy procedure. It is advisable that in patients with operative risk factors, such as distension of atria, long cardiac procedure and likely ischemia of organs due to cardiopulmonary bypass, the monitoring probe of TEE should not constantly rest in the esophagus and be withdrawn when it is idle or not in actual use. In addition, if resistance has been met during the intraoperative manipulation of the probe in a patient without previous history of esophageal disease, perforation might suspected if he or she sustains postoperative fever with positive chest X-ray findings.

Aortic Valve↗
PubMed2002

Asymptomatic esophageal perforation caused by late screw migration after anterior cervical plating: report of a case and review of relevant literature.

STUDY DESIGN: This report documents a case of asymptomatic esophageal perforation, secondary to a dislocated and then migrated cervical screw after anterior plating, and reviews the relevant Western literature. OBJECTIVES: To report a rare and potentially dangerous complication and suggest mechanisms of asymptomatic esophageal perforation and healing. SUMMARY OF BACKGROUND DATA: Anterior surgical approaches to the cervical spine have become popular and safer during the past decade. Materials and devices for anterior stabilization have improved in quality and safety. Nevertheless, failure of the devices may occur either because of technical mistakes or rupture. Reoperation is not always necessary, as spontaneous recovery is possible. METHODS: Our patient was operated on for severe cervical spondylotic myelopathy. One year after surgery, one of the screws migrated and was found anteriorly to the spine. Six months later, the screw could no longer be identified, and we concluded that an esophageal perforation had occurred and that the screw had been eliminated through the intestinal tract. The results of esophagoscopy were normal. RESULTS: The neurologic conditions of our patient improved constantly, and his spine alignment was maintained despite the missing screw. CONCLUSIONS: This case demonstrates that a serious complication may not need any treatment. Each case of screw displacement in anterior cervical spine surgery should be evaluated separately in conjunction with the clinical symptoms of the patient, as spontaneous resolution is possible.

Bone Screws↗
PubMed1997

Nonoperative management of esophageal perforations. Is it justified?

OBJECTIVE: Experiences obtained with nonoperative treatment (NOT), i.e. total prohibition of per oral food intake for a minimum of 7 days, administration of combinations of broad-spectrum antibiotics, and parenteral hyperalimentation, are described in the management of esophageal perforations. SUMMARY BACKGROUND DATA: The place, value, and indication of NOT in the management of esophageal perforation has not yet been unequivocally defined. As a result, contradictory data have been published regarding the outcome of NOT. METHODS: During the past 15 years (1979 to 1994), 20 of 86 patients (23.3%) with esophageal perforation have been treated nonoperatively from the outset. In this group, perforations were located to the upper, middle, and lower third of the esophagus in 50%, 30%, and 20%, respectively. In the operative management group (OT)--in which conservative (drainage, endeprothesis), reconstructive (suture, reinforced suture), and radical (resection) surgical methods were applied--lesions were preponderantly located in the lower one third of the esophagus (56.1%--37/66). As to the interval between the perforation and the onset of treatment, 14 patients had been diagnosed within 24 hours, whereas in 6 cases treatment had been begun beyond 24 hours. RESULTS: NOT could be successfully carried out in 16 patients; the decision to use NOT had to be revised in 4 other cases (Table 1). Two patients were lost; the mortality rate was 10% (2 of 20). The rate of complications was lower in the NOT group (20%, or 4 of 20) than in the OT group (50%, or 33 of 66). CONCLUSIONS: NOT can be suggested for the treatment of intramural perforations. In the case of transmural perforation, this approach should be taken into consideration if the esophageal lesion is circumscribed, is not in neoplastic tissue, is not in the abdominal cavity, and is not accompanied by simultaneous obstructive esophageal disease; in addition, symptoms and signs of septicemia should be absent.

Adult↗
PubMed2002

[Conservative management of esophageal perforation after pneumatic dilatation for achalasia].

PURPOSE: To assess the results and indications of conservative management of esophageal perforation following pneumatic dilatation for achalasia. PATIENTS AND METHODS: Thirteen esophageal perforations complicating 524 dilatations in 412 patients (3%) were diagnosed by esophagogram. Medical treatment consisted of nasogastric succion, antibiotics and pleural drainage, if necessary. Conservative surgical treatment included left thoracophrenotomy, perforation closure, controlateral myotomy and anterior fundoplication. Surgical decision was based upon clinical and radiological parameters. Functional outcome was assessed by the means of the Eckardt's grading score. RESULTS: Six patients were successfully managed by medical treatment. Seven patients underwent conservative surgery, three of whom after failure of medical treatment. The presence of a pneumomediastinum at initial presentation led to immediate (n=2) or delayed (n=2) surgery in all instances. No patients died. In the surgical group, morbidity consisted of one wound infection, one pleural effusion and one venous thrombosis. One severe chest infection occurred in the medical group. Oral feeding was reintroduced after a median of 10 and 11 days in the surgical and medical groups, respectively. Functional results were satisfactory and similar in both groups. CONCLUSION: Conservative medical or surgical management of oesophageal perforation following pneumatic dilatation is safe, if the diagnosis is done early. Pneumomediastinum at initial presentation seems to predict failure of conservative medical treatment.

Adult↗
PubMed1990

[Esophageal perforation caused by a foreign body: a conservative approach].

The etiology, diagnosis and therapy of esophageal perforations due to foreign bodies are discussed on the basis of a case and a literature survey. Eighty percent of the esophageal perforations are iatrogenic. Pain is the first symptom. When appearing after manipulation of the esophagus, a perforation should be ruled out by means of radiology. This should be done by soft tissues radiography of the neck, barium study of the esophagus and chest radiography. The early prevention of contamination and administration of antibiotics are important conditions of a successful conservative therapy.

Anti-Bacterial Agents↗