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Results for “ESOPHAGEAL PERFORATION”

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At least 433 records · Page 24Linked to original sources
PubMed1996

Mechanisms and avoidance of esophageal perforation by anesthesia personnel during laparoscopic foregut surgery.

BACKGROUND: This study retrospectively assesses the mechanisms of 13 esophageal or gastric injuries resulting from dilator or nasogastric tube placement during laparoscopic foregut surgery and is intended to assist in determining methods of prevention. METHODS: Information regarding esophageal or gastric injury during laparoscopic foregut surgery was obtained from six experienced laparoscopic surgeons. The specific mechanisms of injury were determined by discussion with the operating surgeon and review of the operative reports. RESULTS: Eleven cases of esophageal or gastric perforation occurred during bougie insertion and two perforations occurred secondary to nasogastric tube placement during Nissen fundoplication or Heller myotomy. Five perforations required conversion to open operation for repair including two delayed thoracotomies. The 13 injuries occurred during the performance of 1,620 laparoscopic foregut operations for an overall incidence of 0.8%. CONCLUSION: Foregut injury resulting from esophagogastric intubation during laparoscopic surgery is more common than expected. Risk factors include esophageal anatomy, intrinsic pathologic changes of the esophagus, and inexperience. Prevention must focus on close communication between the surgeon and anesthesiologist and safe techniques of dilator insertion.

Adult↗
PubMed1987

Esophageal perforation after fiberoptic variceal sclerotherapy.

Our experience and review of the literature suggests that perforation follows fiberoptic sclerotherapy at an incidence of 1-6% per patient. Perforation is delayed for 2-14 days after the procedure and is due to chemical necrosis of the esophageal wall. The risk of perforation is higher in Child's class C patients. The use of large volumes or high concentrations of sclerosant may increase the risk of perforation. To reduce this risk, we suggest a cautious approach to Child's class C patients, with no more than two sclerosis sessions during the first 2 weeks of treatment using less than or equal to 10 ml of 1.5% sodium tetradecyl sulfate per session.

Adult↗
PubMed1977

The treatment of esophageal perforation with delayed recognition and continuing sepsis.

Five patients, recently treated for esophageal ruptures, provided a spectrum of "late" perforations. Treatment was individualized for each patient and ranged from suture closure of the perforation to esophagectomy. Four of the 5 patients survived and now have no dietary restrictions. The goals of treatment should be: (1) elimination of sources of chemical and bacterial soilage; (2) drainage of infected areas; (3) augmentation of host defenses by antibiotics; and (4) provision of adequate nutrition. Several treatment adjuncts, alone or in combination, may be used to accomplish these goals. The selection of treatment methods should be influenced by the site of perforation, the extent of local inflammation, the status of the residual esophagus, the overall status of the patient, and the chronicity of the perforation. As the risk of uncontrolled sepsis increases, the surgeon should take more aggressive and definitive steps, up to and including esophagectomy in certain cases, to prevent further soilage.

Anti-Bacterial Agents↗
PubMed1986

Esophageal perforations: the role of computerized tomography in diagnosis and management decisions.

External drainage is indicated when a neck abscess results from esophageal or hypopharyngeal perforation. Diagnosis, extent of disease, and timing of abscess drainage have traditionally challenged the surgeon in management of the perforated esophagus or hypopharynx. Diagnosis and management decisions are enhanced by use of computerized tomography (CT) as an adjunctive study. Five specific case presentations feature diagnosis and management.

Abscess↗
PubMed1977

[Instrumental esophageal perforations--diagnosis and treatment (author's transl)].

In the last 6 years 16 patients with an iatrogenic esophageal lesion have been treated. Most frequently this lesion results from esophagoscopies and bouginages. Laying of a gastric tube, extraction of a foreign body or dilatation of a cardiospasm are rare reasons for a lesion. Only three patients suffered from cancer. The early diagnosis and immediately operation is decisive for the therapy's success. The operation with primary closure of the defect and drainage should be aspired. After this the best results are levelled. If the surgical operation is carried on after the 24-hours limit, the operation itself is of minor importance as the lethality of these patients is very high and does not depend on the kind of therapy.

Adult↗