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At least 271 records · Page 15Linked to original sources
PubMed1992

One-stage operation for treatment after delayed diagnosis of thoracic esophageal perforation.

Perforation of the thoracic esophagus can be fatal unless diagnosed promptly and treated effectively. The high mortality with delayed treatment is due principally to an inability to effectively close the perforation and prevent leakage. From 1982 to 1988, 7 consecutive patients (aged 16 to 73 years) were treated after a delayed diagnosis (26 hours to 25 days) of thoracic esophageal perforation. In all patients, the perforation was closed after debridement with total exclusion of the esophagus (T-tube cervical esophagostomy plus absorbable ligatures applied to the esophagogastric junction and the cervical esophagus distal to the esophagostomy). Radical decortication and wide mediastinal and pleural drainage were also done. Nutritional supply was given through a feeding gastrostomy. Antibiotics were administered according to the results of cultures. All patients survived. Continuity of the esophagus was established by removal of the T tube and spontaneous absorption of the ligatures. Endoscopy and esophagography performed 4 weeks after the initial operation showed a well-healed esophagus without stenosis or leakage in all patients. No secondary thoracotomy or esophageal reconstruction was necessary. No dysphagia was noted during follow-up (range, 12 to 50 months; mean follow-up, 23 months). We conclude that primary closure of the perforation and total esophageal exclusion with the use of absorbable ligatures and T-tube esophagostomy can provide a one-stage operation with good results for repair of thoracic esophageal perforation diagnosed late.

Adolescent↗
PubMed2002

[Esophageal perforations and fistulas: clinical management].

Aim of this study was the literature review regarding esophageal perforations and fistulas. We examined the most common causes, clinical findings (symptoms and signs), laboratory and imaging studies for differential diagnosis and complications. Finally, we examined the surgical or endoscopic treatment and the prognosis.

Esophageal Fistula↗
PubMed2005

Late hypopharyngo-esophageal perforation after cervical spine surgery: proposal of a therapeutic strategy.

BACKGROUND: Hypopharynx and esophagus are occasionally at risk of perforation after cervical spine surgery. Although relatively rare--compared to the frequency of anterior instrumentation--hypopharyngo-esophageal perforation has to be considered as a late complication. An interdisciplinary surgical strategy is required for treatment. MATERIALS AND METHODS: We herein propose a flow sheet for an interdisciplinary treatment strategy. The concept is based on the authors' personal experiences with this rare complication in a high-volume center for esophageal surgery. RESULTS: Our interdisciplinary surgical strategy is based on three central parameters that determine the course of treatment: (1) The patient's general condition and signs of systemic infection determine the requirement for critical care management. (2) The stability of the spine (to be addressed by the orthopedic surgeon) determines the requirement for dorsal stabilization, prior to the mandatory removal of the anterior osteosynthesis material that is damaging the hypopharyngo-esophageal structures. (3) The surgical strategy for treatment of the gastrointestinal perforation--the decision to undertake either primary repair or resection--is based on its morphological characteristics; whether it is covered or free, whether it is associated with severe local infection or not, whether the defect is small or large. CONCLUSIONS: Hypopharyngo-esophageal perforations after spine surgery are an interdisciplinary challenge, best treated by a concert of specialists (ICU, orthopedic surgeon, and gastrointestinal surgeon).

Adult↗
PubMed1993

[Esophageal perforation in premature newborn infants. Presentation of 8 cases].

We report eight newborn with esophageal perforation. They were preterm infants and received mechanical ventilation for respiratory problem. Six were associated with pneumothorax, three of they show aberrant way of an orogastric tube, and another three show milk fluid in the pleural tube installed for pneumothorax. The management was fasting during ten days, parenteral nutrition, wide spectrum antibiotics, and prevention of complications; surgery treatment is not the first of all recommended at present.

Esophageal Perforation↗
PubMed2003

[Esophageal perforation after an anterior cervical fixation; report of a case].

We report 1 case of esophageal complications after anterior plate fixation of the cervical spine. A 62-year-old man underwent anterior cervical fusion in August 1996, and he did well after the operation. In January 1998, he was hospitalized for cardiac failure and was incubated twice for 10 days to cure. In March 1998, he suffered from dysphagia and continuous fever. Gastric fiberscopy showed the internal defect of esophagus and the plate to fix the cervical spine. He underwent immediate neck exploration via the cervical fusion incision, however he died of sepsis and respiratory failure. An esophageal perforation after an anterior cervical operation is an uncommon but well-recognized complication of the approach.

Cervical Vertebrae↗
PubMed1997

Delayed presentation of esophageal perforation as a result of overtube placement.

The first use of an overtube to assist endoscopy was described more than 20 years ago. Since then a number of uses of overtubes have been described, but relatively few complications have been reported. We report a case of esophageal perforation caused by overtube insertion during endoscopic band ligation of varices. This case is unique in that the patient presented 13 days after the original procedure, and it is the first reported case of esophageal injury involving the modified Bard overtube. The existing literature involving overtube injury is also reviewed.

Aged↗
PubMed1995

[Cervical esophageal perforation caused by a foreign body: a clinical case].

The Authors report a case of cervical esophageal perforation from foreign body. Comparing their experience with data from literature, they point out the diagnostic importance of both X-ray studies, in order to demonstrate the site of the lesion, and CT scans, to have accurate information on perilesional infective complications (abscesses). Early surgical treatment, with primary closure of perforation and adequate drainage, associated with antibiotics and enteral or total parenteral nutrition, allows good results in most cases.

Aged↗
PubMed1976

Esophageal perforation in the neonate. A review of the literature.

The clinical and roentgenographic findings in traumatic esophageal perforation in the newborn are specific enough to enable a diagnosis to be made rapidly. A case of this entity is discussed and the literature on this subject is reviewed. This case demonstrates that the diagnosis can be strongly suspected from the findings on the chest roentgenogram and confirmed by performing an esophagram.

Diagnosis, Differential↗
PubMed1995

[Early diagnostic pitfalls in esophageal perforation and spontaneous rupture of the esophagus].

In this retrospective study (1981-1993) of 31 cases of esophageal perforations and ruptures circumstances the delay or misdiagnosis with undoubtable influence on the survival have been discussed. The over-all mortality was 16.1% but in cases of early (24 h) perforations or ruptures (12) no patients were lost. The unfavourable consequence of the superficial case history, underestimated pain, incomplete roentgenographic study, diagnostic confusion inadequate surgical exploration and misinterpreted postoperative complications of the formal esophageal surgery are analyzed. The authors emphasized the methods to decrease the number of the false-negative contrast esophagograms as well as the value of the intraoperative endoluminal diluted methylin-blue injection to detect esophageal leak. The early diagnosis is the first prerequisite for a favourable outcome in this life-threatening emergency.

Adult↗
PubMed2002

Esophageal perforation after fracture of the cervical spine: case report and review of the literature.

We present a posttraumatic esophageal tear that occurred in a 55-year old patient after a truck accident. He sustained a two-level injury with a type II odontoid fracture and a unilateral fracture of the left superior articular process of C6 with an incomplete quadriplegia at C5. Both lesions were treated nonoperatively. The tear was attributed to the stretching of the esophagus over anterior degenerative spurs at the level of the lesion (C5-C6) during hyperextension. The diagnosis of the esophageal perforation was delayed for 6 days. The treatment consisted of surgical debridement, volume expansion, antibiotic therapy, hyperbaric oxygenation, assisted ventilation, and esophageal exclusion. A complete review of the literature was performed.

Cervical Vertebrae↗
PubMed1998

The role of esophagectomy in the management of esophageal perforations.

BACKGROUND: Despite the many advancements made in thoracic surgery, the management of patients with esophageal perforation remains problematic and controversial. METHODS: Between 1985 and 1995, 27 esophagectomies were performed for perforation of the thoracic esophagus. A retrospective review of the records of these patients was carried out, and a scoring scale developed by Elebute and Stoner to grade the severity of sepsis was applied. RESULTS: Among the 27 patients undergoing esophagectomy for a perforation, the interval between rupture and esophagectomy was less than 24 hours in only 11 patients (40.7%). Postoperative surgical complications occurred in 4 patients (14.8%) and nonsurgical complications, in 7 (25.9%). The hospital mortality rate was 3.7% (1/27). In 14 patients, primary reconstruction was performed in the bed of the excised esophagus. There were no anastomotic leaks in this subgroup. This suggests that an anastomosis between viable, well-vascularized tissues is more important for successful healing than avoidance of some degree of contamination of the adjacent mediastinum. On follow-up, which averages 41 months, 73% of patients (16/22) have neither symptoms nor complaints. CONCLUSIONS: Esophageal resection definitively eliminates the source of intrathoracic sepsis, the perforation, and the affected esophagus. Reconstruction carried out in one stage does not increase operative morbidity. Esophageal resection and reconstruction is a valid approach even in cases of spontaneous perforation in which the diagnosis is markedly delayed.

Adult↗