Late esophageal perforations.
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Esophageal Perforation↗
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Occult spontaneous esophageal perforation. Unusual clinical and radiographic presentation.
We report a unique presentation of spontaneous esophageal perforation or Boerhaave's syndrome. Our patient had no risk factors predisposing her to barogenic rupture of the esophagus, and she had none of the "classic" presenting signs. She was asymptomatic, and her clinical course appeared to be chronic. Her chest roentgenogram demonstrated bilateral thick-walled cavities with air-fluid levels. Computerized axial tomography of the chest and swallow of meglumine diatrizoate (Gastrografin) showed the cavities and esophagus to communicate. This patient's presentation and radiographic studies extend the reported description of Boerhaave's syndrome.
Diatrizoate Meglumine↗
A rare complication after thyroidectomy: esophageal perforation.
A 67 year-old woman with recurrent multinodular goiter was admitted for bilateral near total thyroidectomy. On the postoperative period, a turbid fluid came from suction drain which was due to an esophageal perforation. Esophagoscopy and contrast computerized tomography revealed a perforation in the upper third part of the esophagus. Following nonoperative treatment by restricting oral intake, parenteral administration of antibiotics, and parenteral nutrition for 10 days, the patient has recovered and was discharged without any sequela. We discussed the cause of perforation according to the possible reasons frequently seen in the literature. Among iatrogenic reasons, unsuccessful intubation trials were more common than neck surgery. Key words: Esophagus, perforation, surgery, intubation, thyroidectomy
Aged↗
Primary repair of iatrogenic thoracic esophageal perforation and Boerhaave's syndrome.
Ten patients seen at our unit over a 24-month period with either iatrogenic (n = 5) or spontaneous thoracic esophageal perforations (n = 5) were retrospectively reviewed. Five patients were seen within 24 hours of onset of symptoms, and 5 were seen after 24 hours or later. There was no significant difference in the presentation or subsequent clinical course in patients seen less or more than 24 hours after the onset of symptoms. Nine patients underwent primary repair together with drainage of the mediastinum, and in 1 of these a Heller's myotomy was also performed for achalasia. One patient had a two-stage esophagogastrectomy for a benign esophageal stricture. One patient (10%) with a spontaneous perforation died 48 hours after operation and was found at postmortem examination to have an in situ carcinoma at the site of the perforation. Four patients (40%) had nonfatal complications. Fistulas developed in 3 patients (30%); in 1 of these patients a second thoracotomy and a further rib resection was required for drainage of a mediastinal abscess. An esophago-cutaneous fistula and a persistent mediastinal abscess developed in 1 patient (10%) and necessitated two further thoracotomies for effective drainage. The mean hospital stay was 38.4 +/- 25.4 days (range, 16 to 76 days). The findings of this study suggest that primary repair combined with a drainage procedure is the treatment of choice for patients with a perforated intrathoracic esophagus, including those seen more than 24 hours after the onset of symptoms.
Aged↗
Carmi syndrome complicated by pharyngo-esophageal perforation.
We describe a neonate having congenital pyloric atresia (CPA) associated with epidermolysis bullosa (EB), also known as Carmi syndrome. The case is unusual as it was complicated with pharyngo-esophageal perforation (PEP) and a definite family history of EB in pervious generations could be recorded.
Combined Modality Therapy↗
Esophageal perforation by a tooth in child abuse.
A unique case of child abuse in a six-year-old Hispanic girl is reported. In this case, a tooth avulsed and swallowed during an episode of physical abuse and/or sexual abuse, caused an esophageal perforation resulting in a retropharyngeal abscess and mediastinal abscess containing the tooth. Although traumatic esophageal injuries in child abuse have occurred, the presence of a tooth within the mediastinal abscess is an unique manifestation of child abuse.
Abscess↗
[Therapy of spontaneous esophageal perforation].
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Adult↗
Fracture of the thoracic spine with paralysis and esophageal perforation.
A 17-year-old young man presented with a highly unstable fracture dislocation of the third and fourth thoracic vertebrae with neurological deficit, in which the fractured spine had perforated the thoracic esophagus. Open reduction and internal fixation of the spinal fractures in combination with aggressive treatment of the mediastinitis caused by esophageal perforation, consisting of two re-thoracotomies, was performed. Two years after the accident, the patient had recovered well. The neurological deficit had recovered, and there were no difficulties with swallowing.
Adolescent↗
Tortilla corn chip-associated esophageal perforation: an unusual presentation of achalasia.
Laceration of the esophagus related to ingestion of tortilla corn chips has been described in the past. However, no cases of perforation of the esophagus are known to be associated with tortilla corn chip ingestion. We describe a case of previously undiagnosed achalasia in a patient who presented with an esophageal perforation after ingestion of tortilla corn chips.
Adolescent↗
Delayed presentation of esophageal perforation simulating paraesophageal hernia.
Generally, benign lesions, which make up the majority of mediastinal tumors and cysts, are asymptomatic; however, they may produce clinical findings. We report on a patient with presumed silent esophageal perforation whose clinical and radiologic assessment was suggestive of massive paraesophageal hiatus hernia. However, surgery revealed a paraesophageal cyst and histology was reported as acute organizing pleurisy. A reasonable, tentative, preoperative diagnosis for each mediastinal lesion can be frequently made by considering its location in the mediastinum, the age of the patient, the presence or absence of local or constitutional symptoms and signs, and the association of a specific systemic disease state. However, the precise nature of a lesion in the mediastinum, as elsewhere, cannot be determined without histologic examination of the tissue. To our knowledge, this unusual clinical case is not been reported in the literature.
Aged↗
[Acute mediastinitis due to esophageal perforation--a case report].
A 55-year-old female consulted her family physician because of pharyngeal discomfort after eating a fish. She underwent rigid fiberscopy and was pointed out a fish bone. Family physician failed to extract the bone and the patient was referred to our hospital. However, there was no fish bone in the esophagus when she underwent second rigid fiberscopy. After eight days she complained of dyspnea and was referred to our hospital again. Chest X ray film showed marked enlargement of the mediastinum and she was diagnosed as acute mediastinitis. She underwent mediastinal drainage by thoracotomy. So tiny perforation was found in cervical esophagus by endoscopy that primary suture was not done. After two months' follow up with intravenous hyperalimentation, there was still esophageal perforation. She underwent the second operation of primary closure with reinforcement using sternocleidomastoid muscle. Two weeks after the second operation esophagogram still showed a fistula. So she received injections of alprostadil and factor XIII. One month after the injections esophagogram showed a diverticulum without leakage.
Acute Disease↗
Esophageal perforation.
Sixty-nine patients with perforation of the esophagus were treated at the University of California, San Francisco, from 1977 to 1988. The perforation was iatrogenic in 33 (48%) of the patients, spontaneous in 8 (12%), and a result of external trauma in 23 (33%). Clinical findings included chest pain in 36 (52%) of 69 patients, subcutaneous emphysema in 22 (32%) of 59 patients, and pneumomediastinum in 21 (36%) of 59 patients. Esophagograms demonstrated the perforation in 40 (93%) of 43 patients. Treatment delays of more than 24 hours occurred in about half of spontaneous and iatrogenic perforations, but when the perforation was due to external trauma, treatment was delayed infrequently. Operative therapy in 59 (86%) of the patients included primary closure in 44 patients, drainage alone in 9 patients, and Celestin tube placement in 1 patient. Four patients with benign strictures had esophagectomy, and 4 patients with achalasia had Heller myotomy in addition to closure of the perforation. Eight (12%) of the patients were treated nonoperatively. For thoracic perforations, nonoperative treatment was reserved for patients who were diagnosed late but who had minimal evidence of sepsis. Seven (10%) of the patients died. Factors that influenced outcome included cause of perforation, anatomic location, and patient age. Our study shows that a high index of suspicion, aggressive use of esophagography, and individualized treatment are necessary for the best results when treating esophageal perforation.
Adolescent↗
Delayed lower esophageal perforation: management with Celestin tube.
Rupture of the esophagus carries a high mortality rate with delayed closure in the compromised patient. In the five patients observed at the Virginia Mason Medical Center, Seattle, we had uniform success in controlling infection and in resolution of the fistula with the use of the Celestin tube. We feel this method is simple, effective, and worthy of further evaluation for treatment of the complicated esophageal perforation.
Adult↗
Heterotopic gastric mucosa in the upper esophagus ("inlet patch"): a rare cause of esophageal perforation.
We report the case of a 21-yr-old woman who presented with a perforation of an upper esophageal ulcer on a patch of gastric-type mucosa. Despite surgical closure of the perforation and reinforcement with a pleuro-muscular flap the patient developed an esophageal leakage and died in the postoperative period. Heterotopic gastric mucosa in the upper esophagus is usually an asymptomatic abnormality, discovered incidentally during endoscopic studies carried out for some other reason; however, complications secondary to the inlet patch acid secreting capacity can arise, and this has to be kept in mind to elude life-threatening conditions.
Adult↗
Esophageal perforation caused by a press through pack.
A 73-year-old woman complaining of sudden hoarseness visited our hospital 17 days after the onset. The upper gastrointestinal contrast study showed a shallow ulcer crater with moderate bulging in the upper thoracic esophagus. Endoscope and computed tomography revealed an esophageal foreign body, a Press Through Pack (PTP), in the esophageal ulcer. The PTP could be removed endoscopically. Two months after extraction of the PTP, the patient was taking normal food orally and was discharged. The esophageal perforation, looking like a diverticle, was still present more than 1 year after the onset.
Aged↗
Cervical esophageal perforation with severe mediastinitis due to an impacted dental prosthesis.
We herein report about a case of perforation of the cervical esophagus by an artificial denture, which had been swallowed by the patient after a horse-related-injury. Impactation of the foreign body at the level of the upper esophageal sphincter was followed by its penetration through the esophageal wall, causing severe infection of the cervical soft tissue, mediastinitis and sepsis. We discuss the well-known phenomena of prosthesis ingestion and frequently delayed diagnosis, as well as our treatment strategy of cervical esophageal perforation with placement of a T-tube into the cervical esophagus and mediastinal drainage.
Dental Prosthesis↗
Esophageal perforation by echoprobe during cardiac surgery: treatment by endoscopic stenting.
The usefulness and safety of transesophageal echocardiography during cardiac surgery have been well described in the literature. However, rare complications of this procedure can occur and should be familiar to surgeons and anesthesiologists. A case of esophageal perforation by echoprobe during coronary artery bypass grafting treated successfully by endoscopic stenting is reported.
Aged↗
The diagnosis and management of esophageal perforations.
Despite the widespread availability of flexible fiberoptic upper gastrointestinal endoscopes, perforation of the esophagus continues to pose a formidable diagnostic and therapeutic problem for the clinician. Failure to recognize and treat a contained mediastinal perforation can result in death in a matter of hours. The most common etiology is still iatrogenic; therefore, attention to detail and proper training for endoscopists is paramount in reducing the morbidity and mortality associated with this disorder. This article reviews the diagnosis and treatment of esophageal perforation and discusses measures to avoid this potentially lethal complication.
Esophageal Perforation↗