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[Esophageal perforation and mediastinitis caused by fishbone ingestion: report of 3 cases].

We present 3 consecutive cases of fishbone perforation of the esophagus that resulted in acute mediastinitis. All patients were successfully managed with drainage and debridement of the mediastinum and pleural cavity. However, temporary exclusion with external ligation of the esophagus was also performed in one patient, with spontaneous recanalization two weeks later. We discuss the possible role of this surgical maneuver in the management of esophageal perforation.

Adult↗

[A case of giant bronchogenic cyst complicated with postoperative esophageal perforation].

A 42-year-old man with giant bronchogenic cyst occupied from the middle and posterior mediastinum was treated surgically. The tumor was stoutly adhered to anterior aspect of the esophagus and membranous portion of the right bronchus. In dissecting the tumor, muscular coat of the esophagus was partly severed, which was repaired interruptedly with absorbable suture material. However, esophageal perforation was detected by barium swallow on the 3rd postoperative day. Conservative therapy included intrathoracic drainage and antibiotics was successfully undertaken. It is imperative to dissect the tumor very carefully if the giant bronchogenic cyst adheres to the esophagus or other surrounding organs.

Adult↗

Esophageal perforation during attempted endotracheal intubation.

Perforation of the cervical esophagus in the course of attempted intubation of the trachea is a very rare accident, or at least rarely reported. Over the past 11 years, 12 patients ranging in age from 44 to 72 years were treated in our unit. If suspected, esophageal perforation is easy to diagnose when intubation has been difficult or when the patient complains of dysphagia and neck pain. Subcutaneous cervical emphysema appears early. All the patients who were operated upon early made an uneventful and prompt recovery. In those subjected to delayed operation (more than 12 hours) or nonoperative treatment, the mortality rate was 56 percent and recovery was achieved only after long and difficult treatment.

Adult↗

Esophageal perforation associated with profound shock successfully managed with hemodynamic assistance using percutaneous cardiopulmonary support.

A 51-year-old man was admitted to our hospital with complaints of severe chest pain, nausea, and vomiting. These symptoms had progressed rapidly and he was in shock. It was necessary to make a correct diagnosis as early as possible. However, the hemodynamic condition of the patient deteriorated rapidly before a definitive diagnosis could be established in spite of conventional therapies. Under hemodynamic assistance with percutaneous cardiopulmonary support (PCPS), a final diagnosis of esophageal perforation was made by esophagography. Our report illustrates a new application of PCPS for highly selected cases of noncardiogenic shock as a "bridge" until an accurate diagnosis is made and a specific treatment is applied.

Cardiopulmonary Bypass↗

Esophageal perforations, anastomotic leaks, and strictures: the role of prostheses.

Misfortunes deriving from esophageal anastomotic leaks, perforations, and strictures are surgical problems of major magnitude, especially when a delay in treatment exceeds 12 hours. To this date, there is not unanimity in the approach to these problems. The costs in hospital expense, morbidity, and mortality are such that methods thought to improve outcome should be given careful consideration. The author presents personal experience with intraluminal stenting under various circumstances with Celestin and Hood prostheses that seems to support their use in esophageal surgery as others have found in colon surgery. Further study of this method is suggested.

Anastomosis, Surgical↗

[Conservative treatment of esophagus ruptures and perforations. Esophageal diversion by minimal pharyngostomy].

In ruptures or perforation of the oesophagus, the difficult choice between conservative methods (suture or drainage) and total exclusion of the organ can be avoided by minimal pharyngostomy. This procedure, which supersedes lateral oesophagostomy and makes use of an aspiration silicone-lined catheter to divert the oesophageal contents, is simple, rapid, effective and reversible. It is carried out in a region devoid of dangerous anatomical variants, in the avascular space below the greater cornu of the hyoid bone (a palpable landmark), the incision being made on the convexity of a curved clamp which pushes back the pharyngeal wall at the level of the sinus pyriformis. This technique has been used in 13 patients with satisfactory results.

Esophageal Diseases↗