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PubMedDate not supplied

Respiratory distress due to esophageal perforation caused by ball point ingestion.

A 15-month-old girl who developed respiratory distress which persisted for three days prior to admission demonstrated pleural effusion on the chest x-ray which was determined to be due to esophageal perforation caused by the ingestion of a ball point. A gastrotomy was performed to extract the ball point. A gastrostomy was performed and a chest tube was inserted. The esophagus was normal radiologically within one month. Foreign body ingestion may cause esophageal perforation in childhood. If it goes unnoticed and a diagnosis is delayed, there is danger of the more hazardous development of mediastinitis. It is important that a child with respiratory distress also be evaluated for esophageal foreign body ingestion.

Dyspnea↗
PubMed1986

Diagnosis and recommended management of esophageal perforation and rupture.

Over the past 47 years (1937 to 1984), a total of 127 patients with esophageal perforation or rupture were evaluated at Duke Medical Center or the Durham Veterans Administration Medical Center. In 13 patients, the diagnosis was established at the time of autopsy and in the remaining 114, the diagnosis was established clinically. The etiology, radiological findings, underlying esophageal disease, time interval between onset of symptoms and therapy, and eventual outcome were evaluated. Patients with anastomotic leaks and those in whom carcinoma resulted in perforation or fistula were excluded. Iatrogenic causes were responsible for 55% of perforations, followed by spontaneous rupture in 15%, foreign body perforation in 14%, and traumatic perforation in 10%. Of the 127 patients, 114 underwent treatment involving primary closure (43%), drainage alone (28%), resection (9%), or nonoperative therapy (20%). The overall mortality among these 114 patients was 21%. Fourteen patients sustained a major complication requiring additional operative intervention. The overall mortality among patients requiring reoperation was 57%. Survival was significantly influenced by a delay in treatment of greater than 24 hours. With the exception of nonoperative therapy, survival was improved for all forms of treatment instituted within 24 hours. Primary closure within 24 hours resulted in the most favorable outcome (92% survival). In addition to early treatment, other factors associated with a favorable outcome included traumatic perforation (100% survival), foreign-body perforations (94% survival), and iatrogenic causes (80% survival). Spontaneous rupture resulted in the lowest survival (37%). The incidence of esophageal perforation has increased dramatically since 1967.(ABSTRACT TRUNCATED AT 250 WORDS)

Esophageal Perforation↗
PubMed1989

Boerhaave revisited: spontaneous esophageal perforation as a diagnostic masquerader.

Spontaneous perforation of the esophagus (Boerhaave syndrome) is an emergency that requires early diagnosis if death or serious prolonged illness is to be averted. The cases of three patients with spontaneous esophageal perforation simulating other primary diagnoses are described. The respective referral diagnoses were pericarditis, lung abscess, and pancreatitis. Each case was characterized by severe illness, and by delay in diagnosis despite multiple consultations. Two patients died. The literature is reviewed and the causes of delay in diagnosis are analyzed. More than 40 years after the first report of successful surgical repair, spontaneous esophageal perforation is insufficiently considered in diagnostic hypotheses, yet may be confirmed or excluded by simple methods. All clinicians need to be alert to this lethal disease, and to be aware of its frequent atypical presentations.

Aged↗
PubMed2003

Esophageal perforation and neck abscess from ingested foreign bodies: treatment and outcomes.

Over a 6.5-year period, 5,848 patients who had ingested a foreign body were admitted to the ENT unit at the Prince of Wales Hospital in Hong Kong. Potentially serious complications developed in 12 patients (0.21%). Eight patients had an esophageal perforation; three had clinical evidence that their injury had been caused by the foreign body itself and five were deemed to have been injured iatrogenically during esophagoscopy. One of the latter group eventually developed an abscess. Four patients originally presented with an abscess. Three of these patients and the patient who later developed an abscess were treated with neck exploration and surgical drainage. One of the patients who initially presented with an abscess refused surgical treatment and was treated conservatively. Conservative treatment was also initiated for all patients who had a perforation. Patients on the conservative regimen were administered intravenous broad-spectrum antibiotics and were not permitted to take any food or liquids by mouth; they received their nutrition via either enteral feeding or total parenteral nutrition. Conservative treatment was successful in all seven patients with a perforation and no abscess and in the one patient with an abscess who refused surgery. Moreover, all four patients who underwent surgical treatment recovered. Our experience demonstrates that esophageal perforation related to an ingested foreign body can be safely treated by conservative means if the diagnosis is made before significant contamination occurs. Conversely, abscesses (cervical or mediastinal) related to an ingested foreign body should be explored and surgically drained.

Abscess↗
PubMed1994

[Esophageal perforation after replacement of descending thoracic aorta for rupture mycotic aneurysm].

Primary mycotic aneurysm of the thoracic aorta has rarely been reported. The patient was a 61-year-old male who had a ruptured mycotic aneurysm of the descending thoracic aorta without any evidence of infectious disorders in his history. The patient developed esophageal perforation after graft replacement of the descending thoracic aorta. After continuous irrigation of the left pleural cavity and the mediastinum for one month, the thoracic esophagus was resected and reconstructed. However, the patient died of DIC following uncontrolled sepsis on the 98th postoperative day. Pathogenesis of the esophageal perforation and operative procedures that might have been effective in saving the patient were discussed.

Aneurysm, Infected↗
PubMed2002

Esophageal perforation associated with noninvasive ventilation: a case report.

Noninvasive positive-pressure ventilation (NIPPV) is widely used to treat acute respiratory failure, the goal being to avoid exposing patients to the morbidity associated with tracheal intubation. NIPPV may reduce the rates of intubation, morbidity, and mortality in selected patient subgroups. Although time-consuming for physicians and nurses, NIPPV is fairly easy to use, and few severe complications have been reported. Esophageal perforation is a well-recognized complication of tracheal intubation but has not been described in association with NIPPV. We report a case of fatal esophageal perforation associated with NIPPV after a surgical procedure.

Esophageal Perforation↗
PubMed2004

[Esophageal perforation by portions of a wild boar].

We report a case of esophageal perforation by impacted portions of a wild boar. The 77-year-old patient was admitted 5 days after an opulent dinner. He complained of dysphagia and retrosternal pain and showed signs of severe sepsis. Endoscopy revealed meat and bone portions impacted in the esophagus. Surprisingly, impactation had not happened near any of the anatomical narrowings, but in the middle third. A CT scan showed penetration of the foreign body into the mediastinum and purulent mediastinitis. The patient underwent transthoracic esophagectomy and drainage of the severe, purulent mediastinal infection. Postoperative multi organ failure required a prolonged treatment in the intensive care unit. After recovery the gastrointestinal continuity was restored with gastric pull-up in the anterior mediastinum. The further course was uneventful.

Aged↗
PubMedDate not supplied

Spontaneous esophageal perforation presenting with right-sided pleural effusion.

Boerhaave's Syndrome (spontaneous esophageal perforation) is an uncommon clinical entity that frequently presents with an antecedent history of marked vomiting followed by chest or abdominal pain. Misdiagnosis is the most important contributing factor in the continuing high morbidity and mortality of this disease. We report an atypical presentation of Boerhaave's Syndrome in an elderly female who presented to the Emergency Department with dyspnea, right sided chest pain, right pleural effusion, and hypovolemic shock without an identifiable antecedent event. A chest radiograph revealed massive right hydropneumothorax. After placement of a chest tube, the patient was admitted to the intensive care unit. Only 36 hours after admission did the diagnosis of Boerhaave's Syndrome become evident. She underwent operative repair and, after a prolonged stay, was discharged in relatively good condition 3 months after her admission. The absence of vomiting prior to presentation and the right sided effusion are the distinguishing features of this particular case.

Emergencies↗
PubMed1999

Thoracic esophageal perforations: surgical management with mechanical bipolar exclusion.

We report 12 cases of thoracic esophageal perforation diagnosed during the last seven years. Management was nonsurgical in 2 patients and the rest were treated surgically. Primary repair and drainage were performed in 2 patients, and 7 patients underwent suture of the perforation and bipolar exclusion using nonresorbable staples. The remaining patient was treated with proximal unipolar exclusion. The approach was always through a posterolateral thoracotomy. The result was optimal in 8 patients; the most important postsurgical complications were 2 esophageal fistulas that required surgery, and only one of the patients died of fulminating sepsis. Bipolar exclusion is a procedure that needs only one operation and provides excellent morbidity-mortality rates compared with other exclusion techniques with later reconstruction. We consider suturing with nonresorbable staples to be a simple and safe procedure, with spontaneous recanalization of the esophageal lumen in 2 weeks.

Adult↗
PubMed2006

Esophageal perforation caused by fish vertebra ingestion in a seven-month-old infant demanded surgical intervention: A case report.

A seven-month-old infant was admitted to our hospital with a 1-wk history of shortness of breath, dysphagia, and fever. Diagnosis of esophageal perforation following fish vertebra ingestion was made by history review, pneumomediastinum and an irregular hyperdense lesion noted in initial chest radiogram. Neck computed tomography (CT) confirmed that the foreign body located at the cricopharyngeal level and a small esophageal tracheal fistula was shown by esophagogram. The initial response to treatment of fish bone removal guided by panendoscopy and antibiotics administration was poor since pneumothorax plus empyema developed. Fortunately, the patient's condition finally improved after decortication, mediastinotomy and perforated esophagus repair. To our knowledge, this is the first case report of esophageal perforation due to fish bone ingestion in infancy. In addition to particular caution that has to be taken when feeding the innocent, young victim, it may indicate the importance of surgical intervention for complicated esophageal perforation in infancy.

Animals↗
PubMed1986

Esophageal perforation secondary to gastrostomy tube replacement.

A 6-week-old child with esophageal perforation secondary to a misplaced gastrostomy Foley balloon is described. She was treated successfully with chest tube drainage, antibiotics, and total parental nutrition. This may be an alternative method of treating this rare complication of gastrostomy.

Catheters, Indwelling↗
PubMed2004

Primary endoscopic management of esophageal perforation following transesophageal echocardiogram.

A 90-year-old woman sustained a proximal esophageal perforation following transesophageal echocardiography. The perforation originated at the site of a Zenker's diverticulum and resulted in a false passage to the diaphragm. Initial management involved endoscopic placement of drains into the mediastinum in addition to bilateral chest drains and a gastrostomy. Following stabilization, the patient had repair of her Zenker's diverticulum and recovered uneventfully. We recommend that all procedures involving blind intubation of the esophagus should be preceded with specific pursuit of a background of cervical dysphagia.

Aged↗
PubMed2006

Repairing esophageal perforations with a transverse cervical musculofascial flap.

OBJECTIVES/HYPOTHESIS: Although rare, perforations of the esophagus following spinal surgery via an anterior approach are serious life-threatening problems. Complications include abscess formation, mediastinitis, sepsis, and fistula that can carry a mortality rate of 20%-50%. Early diagnosis and treatment are imperative. A common method of repair is isolation and primary repair of the defect in the esophagus, with interpositional muscle coverage. A transverse cervical myofascial artery flap is described here as a potential reconstructive option. STUDY DESIGN/METHODS: Retrospective review was performed on 3 patients who had repair of esophageal perforations following spinal surgery with an anterior approach. RESULTS: In all 3 cases, hardware was found to be eroding through the esophagus. The hardware was removed at the time of repair and flap coverage in 2 patients, and each went on to an oral diet within 10 days without complication, with follow-up exceeding 6 months. A third patient with recurrent erosions could not have the hardware removed and subsequently suffered with another erosion through the muscle flap. A secondary surgery with pectoralis flap coverage was successful but required revision surgeries for flap debulking. No patients had limitation of shoulder movement after flap reconstruction, and all went on to a normal diet without dysphagia. CONCLUSIONS: The transverse cervical artery musculofascial flap can be an ideal method for repair of small cervical esophageal perforations, although spinal hardware should be removed if felt to be the etiology of the perforation.

Adult↗