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At least 649 records · Page 36Linked to original sources
PubMed1997

[Esophageal perforations and ruptures: a plea for conservative treatment].

OBJECTIVES: To identify the determinants and results on conservative management of oesophageal perforations and ruptures. METHODS: Retrospective clinical review of 34 consecutive patients (mean age: 62 years) treated for cervical (n = 10) or thoracic (n = 24) oesophageal disruption between 1985 and 1996. Causes were: spontaneous rupture (n = 10), instrumental perforation (n = 16), alimentary foreign body (n = 6), and blunt (n = 1) or penetrating trauma (n = 1). The diagnostic delay exceeded 24 hours in 15 cases. RESULTS: A nonoperative management was achieved in 8 patients with no mortality. A conservative surgical treatment was attempted in 23 patients, primary repair in 21 and open drainage in 2, with a 17.4% mortality. Resection (n = 2) or exclusion (n = 1) was performed in 3 patients with no early mortality, but one of them died as result of the subsequent reconstructive operation to restore oesophageal continuity. Overall morbidity was linked to the spontaneous cause of the perforation. Outcome of patients undergoing primary repair was not influenced by the diagnostic delay nor the surrounding sepsis. CONCLUSION: Conservative management should be advocated for the treatment of oesophageal perforations and ruptures, even in case of delayed diagnostiqiagnosis, regardless of the surrounding sepsis and cause of disruption.

Adult↗
PubMed1994

[Satisfactory results of conservative treatment in traumatic esophageal perforation].

OBJECTIVE: Evaluation of diagnosis and management of 18 patients with iatrogenic or traumatic oesophageal perforation. DESIGN: Descriptive retrospective. SETTING: University hospital Vrije Universiteit Amsterdam. PATIENTS AND METHODS: In the period 1981-1991 18 patients received conservative treatment for iatrogenic/traumatic oesophageal perforation. RESULTS: The perforation was located in the cervical part of the oesophagus in 13 cases and in the thoracic part in 5 cases. Various incidents had led to the perforation. For radiological examination X-rays of the thorax or lateral neck were made or an oesophagogram using iodine as the contrast medium. Treatment consisted of antibiotics, a stomach catheter, intravenous nutrition and if necessary suction drainage. Seventeen patients recovered completely, one patient died. CONCLUSION: Conservative treatment of iatrogenic oesophageal perforation consisting of antibiotics, stomach catheter, enteric or parenteral nutrition and if necessary suction drainage gives good results.

Adult↗
PubMed1990

[The diagnosis and therapy of esophageal perforation or rupture in infancy and childhood].

Oesophageal perforation or rupture is rare in childhood; recently there has been an increase, mostly due to the more frequent use of endoscopy in neonates. The prognosis depends largely on early diagnosis and the type of treatment. The author has seen eight children, aged between one day and nine years, with oesophageal lesions. Of these, six had a perforation and two a rupture of the oesophagus. The problems of diagnosis and treatment and their complications are discussed with reference to these patients. Stress is laid on the importance of early diagnosis. In children, contrary to the case in adults, conservative treatment is often possible.

Child↗
PubMed1980

Esophageal perforations in premature infants and comments on the diagnosis.

Traumatic perforation of the esophagus follows oropharyngeal suctioning or endotracheal intubation. The diagnosis frequently is made from a routine chest roentgenogram that shows a nasogastric tube in the right pleural space with or without a pneumothorax. The lesion is seen most often in infants of low birth weight.

Esophageal Perforation↗
PubMedDate not supplied

[Surgically treated esophageal perforation caused by metal esophagoscope].

A case of oesophageal perforation is described occurring during oesophagoscopy carried out in search for a foreign body. After several hours of observation the hole in the oesophagus was closed with sutures. The postoperative course was complicated with posterior mediastinitis and suture failure. After active aspiration drainage and broad spectrum antibiotics the patient was cured.

Adult↗
PubMed1991

[Conservative treatment of esophageal perforations following pneumatic dilatation].

Over a 15-year period we have treated 50 patients with achalasia by pneumatic dilatation (61 dilatations). Perforation occurred in 5 patients, 2 of whom required surgery while the other 3 were successfully managed by conservative means. These 3 patients are reported on with reference to the indications and modalities of the medical treatment.

Adult↗
PubMed1995

How to avoid esophageal perforation while performing laparoscopic dissection of the hiatus.

An increasing number of surgeons attempt advanced laparoscopic procedures, involving the distal esophagus such as Nissen fundoplication, truncal vagotomy, and Heller's myotomy. At this time, there are probably as many techniques as there are surgeons. The authors have tried to provide a "ready to use" universal strategy that details how to approach the distal esophagus while avoiding the dangerous pitfalls of surgery in that area.

Adolescent↗
PubMed1982

[Esophageal perforation during tracheal intubation. Report on 6 cases. (author's transl)].

Perforation of the esophagus and hypopharynx followed tracheal intubation for general anesthesia or during intensive care in 6 patients. Circumstances favorable to the production of these lesions, and diagnostic features enabling early diagnosis are discussed. Simple surgical procedures and intensive postoperative care resulted in recovery in 5 of the 6 cases.

Aged↗
PubMed1996

[Esophageal perforations].

An oesophageal perforation is a serious condition with high morbidity and mortality. During the latest decades an increased number of traumatic perforations as well as wide use of endoscopic procedures have increased the incidence of oesophageal perforation. An early diagnosis and treatment is important for the prognosis. Cervical and selected thoracic perforations can be treated conservatively although the majority should be operated. Primary closure can be performed if done before 24 hours have elapsed, while later treatment is controversial. Drainage of the mediastinum and pleural space, as well as diversion of saliva and gastric content is important. The literature is reviewed in relation to etiology, diagnosis, treatment and prognosis.

Esophageal Perforation↗
PubMed2004

Esophageal perforation as a complication of EndoCinch endoluminal gastroplication.

Endoscopic gastroplasty is being promoted as a new minimally invasive procedure for the treatment of gastroesophageal reflux disease. In the case presented here, however, we encountered abdominal perforation as a severe complication of this procedure. Because immediate action was taken when the symptoms developed, and by maintaining close collaboration with the surgeons, it was possible to keep the treatment minimally invasive: the leakage was detected endoscopically and the defect was closed laparoscopically and covered by a fundoplication. This experience emphasises the importance of appropriate management of complications as part of the evaluation of new endoscopic methods.

Adult↗
PubMed1998

[Esophageal perforations. Diagnosis and treatment].

Perforation of the esophagus was retrospectively analysed in six patients. The age span was 30 years to 81 years, and the male to female ratio was 2 to 1. Each case was studied with regard to presentation, etiology, treatment and complications. The diagnosis was made at postmortem examination only in 1 patient. The perforation was iatrogenic in 1 of the patients and spontaneous in 5. Management was nonoperative in 3 cases and primary repair with drainage was performed in 2 patients. Overall mortality rate for the series was 33%. This series accumulated from a review of the literature emphasizes the importance of the influence of different methods of treatment and time lapsed between occurrence and therapy.

Adult↗
PubMed1996

[Benign esophageal perforations treated at a department of thoracic surgery].

Between January 1, 1980 and December 31, 1994, 37 patients with benign oesophageal perforation underwent different kinds of treatment. The overall mortality was 30%. When diagnosed less than 12 hours after the perforation the mortality was 21%, between 12 and 24 hours. Reinforced primary repair gave the best results without any deaths in seven cases where it was performed. Oesophageal perforation is a serious condition, and it is important to know the symptoms. If there is any suspicion of the condition, an oesophageal X-ray with watersoluble contrast medium should be performed on liberal indication. When diagnosed the patient should be transferred to a Department of Thoracic Surgery immediately. Only few patients can be treated conservatively and most should be operated with reinforced primary suture and drainage.

Adolescent↗
PubMed1985

[Instrumental esophageal perforation--its treatment and results].

The number of oesophagus perforations has increased considerably with the increase in endoscopic, diagnostic and therapeutic procedures. 46 instrumental oesophagus perforations have been observed between 1973 and 1984. The youngest patient was a 2-year-old girl with a benign oesophagus stenosis and the eldest was an 89-year-old man with a neoplasm of the cardia. The average age was 62 years. 26 patients were treated conservatively; 20 patients were treated surgically. In 2 cases the oesophagus was diverted at the cervical level and the cardia detached. 8 months later this was successfully reconstructed. 9 out of 43 patients died. In every case, the cause of death were cardio-pulmonal complications accompanying general sepsis.

Adolescent↗
PubMed1997

Surgical management of late esophageal perforation.

Over sixteen years we have gained experience in the delayed surgical management of esophageal rupture in nine patients who received treatments more than 24 hours after perforation. The causes of perforation were Boerhaave's syndrome or barotrauma in four patients, foreign bodies in two, and other causes in three. Three patients presented in septic shock and four in respiratory failure. Three surgical options were used for treatment: simple thoracic drainage in two patients, T-tube placement in four, and esophagectomy with secondary reconstruction in three. Eight patients (89%) survived. T-tube placement was effective in that it was a one-stage operation which could be used on severe esophageal injuries in patients in poor general condition. Three patients who underwent esophagectomy and secondary alimentary restoration required long hospital stays (119,201, and 648 days). Although the number of cases is small, T-tube insertion for the late management of esophageal rupture appears to be a simple and effective method which avoids the postoperative complications associated with primary closure or two-stage operations.

Drainage↗