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At least 361 records · Page 20Linked to original sources
PubMed2004

Two-stage coloesophagoplasty in children with caustic burns of the esophagus: hemodynamic basis of delayed cervical anastomosis--theory and fact.

BACKGROUND/PURPOSE: This study was carried out to survey the outcome in patients with corrosive burns of the esophagus who had undergone 2-stage coloesophagoplasty procedures. METHODS: Records of 81 patients with staged cervical coloesophagostomy procedures have been reviewed. In all cases, colon was pulled through the retrosternal route in an antiperistaltic fashion. The native esophagus was left in place. After the cologastric anastomosis at the antral level, cervical anastomosis was delayed for a second stage. Complications related to the procedure, corrective interventions, and long-term results were evaluated. RESULTS: In all patients, the retrosternal route was used for the replacement of the colon. The conduits were constructed from right colon in 20 (24.7%) and left colon in 61 (75.3%) patients. There were 3 leaks (3.7%) and 9 strictures (11%). Terminal necrosis of the cervical colonic piece occurred in 3 patients who had undergone resection of the sloughed terminal end, and all were further treated by right intrathoracic antehilar coloesophagostomies performed between the remaining parts of the transplanted colon and the upper thoracic esophagus. One of these patients had wound dehiscence with subsequent sepsis and died. CONCLUSIONS: Terminal necrosis of the graft is not related to staging of the technique, but the decreased rate of cervical anastomotic strictures seem to be directly correlated with staging of cervical anastomosis. Possibly, an ischemic anastomosis at the terminal end of the graft after extensive mobilization and retrosternal placement is avoided with a delayed anastomosis performed after full restoration of the microcirculation.

Burns, Chemical↗
PubMed1983

Esophagitis secondary to ingestion of caustic material.

The records of 176 patients admitted to Grady Memorial Hospital over a 10-year period with a history of ingestion of corrosive material were reviewed. Esophagoscopy was performed in 168 patients an average of 15 hours after ingestion. In 94 patients, no esophageal burn was found. Seventy-four others had injury of the esophagus of varying degree; 3 of these had no evidence of oropharyngeal burn. The patients with esophageal injury were treated with steroids for two weeks and antibiotics for 5 days. No complications resulted from esophagoscopy or steroid therapy in any patient. Stricture did not develop in any of the patients in whom esophagoscopy was negative. Documented stricture occurred in 29 patients with esophagoscopic evidence of esophageal burns, 7 of whom did not respond to periodic esophageal dilation and subsequently underwent esophageal bypass. Three patients had symptoms and signs of gastric perforation on the first, sixth, and eighth days after ingestion, respectively, and at laparotomy all of them were found to have severe gastric injury. One of these patients died on the postoperative day 28; this was the only death among all patients seen with history of ingestion of corrosive material. This study suggests that with early esophagoscopy, approximately 55% of patients who ingest corrosive material can be spared the agony and prolonged treatment of possible esophageal injury. Appropriate management will result in preservation of the esophagus in most patients.

Adolescent↗