[Observation of coexistent Mellory-Weiss syndrome and esophageal wall perforation].
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Adult↗
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Results for “ESOPHAGEAL PERFORATION”
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Vertebral osteomyelitis after blunt traumatic esophageal rupture.
STUDY DESIGN: This is a report of a case. OBJECTIVE: To document the occurrence and characteristics of vertebral osteomyelitis after blunt traumatic esophageal perforation. SUMMARY OF BACKGROUND DATA: Vertebral osteomyelitis in association with esophageal rupture has been reported after penetrating, but not blunt traumatic injuries. METHODS: All of the listed authors were involved in the care of this patient. All medical records, laboratory and radiologic investigations, and related literature were reviewed. RESULTS: The mixture of oral aerobic and anaerobic organisms inoculated into vertebral bone after blunt traumatic esophageal perforation caused a rapidly destructive vertebral osteomyelitis reminiscent of bite-wound injuries of the hand. CONCLUSIONS: Awareness of the occurrence of blunt traumatic esophageal perforation and the associated risk of vertebral osteomyelitis may lead to earlier detection and treatment of these infections.
Esophagus↗
Cervical esophageal anastomosis following cervical esophageal diversion: a new use for an old instrument.
Proximal cervical esophageal diversion is occasionally employed in the management of distal esophageal perforation. However, subsequent esophageal reconstruction can pose a formidable surgical challenge. The DeBakey femoral tunneling device has proven helpful in identifying the distal defunctionalized segment of esophagus during certain types of reconstruction. We describe the use of this instrument to reestablish esophageal continuity in two instances.
Esophageal Perforation↗
Perforations after Maloney esophageal dilation.
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Dilatation↗
[A new method of surgical treatment of perforation of cicatricial esophageal stenosis].
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Burns, Chemical↗
Congenital esophageal stenosis owing to ectopic tracheobronchial remnants.
BACKGROUND/PURPOSE: Congenital esophageal stenosis owing to tracheobronchial remnants (TBR) is a rare condition. Inappropriate treatment often is carried out before the correct diagnosis is established. For a better understanding and management of this disease, patients with TBR treated at our hospital and collected from the literature are reviewed to evaluate the course of onset, associated anomalies, methods of diagnosis and treatment, and outcomes. METHODS: Three patients treated at our hospital and 59 patients identified from the literature were included in the study. Gender, age at onset of symptoms, age at definitive treatment, esophagographic findings, pathology, methods of treatment, and outcomes of the 62 patients were recorded and analyzed. RESULTS: Boys slightly predominated (33:28, 1 unknown gender). Symptoms of dysphagia and regurgitation developed at the mean age of 3.2 +/- 4.5 months. Definitive treatment was carried out at the mean age of 2.6 +/- 3.0 years with a time lag of 2.0 +/- 2.5 years from the onset of symptoms. Twenty-five patients had associated anomalies with esophageal atresia being the most prevalent. Esophagography showed segmental stenosis over the distal third of the esophagus in all patients except one. The esophagographic findings could be classified into 3 types: type Ia, 10 cases; Ib, 15 cases; type II, 14 cases; type III, 3 cases. A nonyielding esophageal stenosis without inflammation was the characteristic esophagoscopic finding. Esophagoscopic dilatation of the stenosis was attempted in 26 patients, but all failed, and 2 patients suffered esophageal perforation. Surgical resection was mandatory for all patients to restore their esophageal continuity. Postoperative complications included anastomotic stenosis, anastomotic leakage, hiatal hernia, and gastroesophageal reflux. CONCLUSIONS: TBR should be suspected in patients who present with a typical history of dysphagia after ingestion of solid food and have characteristic esophagographic and esophagoscopic findings. It has a strong tendency to occur with esophageal atresia. Esophagoscopic dilatation is ineffective and may render the patient at risk for esophageal perforation. Operation is the treatment of choice and carries little morbidity and mortality.
Anastomosis, Surgical↗
Gaseous distention of the hypopharynx and cervical esophagus with nasal CPAP: a mimicker of pharyngeal perforation and esophageal atresia.
BACKGROUND: Nasal continuous positive airway pressure (CPAP) has been used since 1975 as the initial treatment for respiratory distress syndrome (RDS) in very premature infants. Gaseous distention of the abdomen (CPAP belly) is a common secondary effect of CPAP. Gaseous distention of the hypopharynx is also common. OBJECTIVE: To determine the incidence of hypopharyngeal distention in infants on CPAP. MATERIALS AND METHODS: We performed a retrospective review of the chest radiographs of 57 premature infants treated with CPAP during a 4-week period to find the presence and degree of hypopharyngeal distention. RESULTS: Of the 57 radiographs, 14 (25%) revealed gaseous distention of the hypopharynx and/or cervical esophagus. On occasion, this raised concern for pharyngeal perforation or esophageal atresia. CONCLUSION: Awareness that CPAP-related hypopharyngeal distention is common should help radiologists avoid erroneous consideration of esophageal atresia or hypopharyngeal perforation.
Continuous Positive Airway Pressure↗
Pneumomediastinum after self-dilation of the esophagus.
Pneumomediastinum following esophageal perforation is a known complication of Eder Puestow dilation for esophageal stenosis. This is the first reported case of esophageal perforation and pneumomediastinum occurring after instrumental self-dilation of a stenotic esophageal lesion. The observed 0.02 percent perforation rate in this patient (compared to the reported 0.3 percent in Eder Puestow "hetero"-dilation) makes the Eder Puestow auto-dilation procedure seem justifiable in a well-trained and well-informed patient.
Aged↗
Radiological findings in Boerhaave's syndrome.
The aim was to define the diagnostic value of chest radiography, esophagography, and computed tomography (CT) in patients with Boerhaave's syndrome. CT findings in 14 patients (11 male, 3 female; mean age: 60 years; median age: 66 years; age range: 36-78 years) with spontaneous esophageal perforation were retrospectively reviewed and compared to those of esophagography ( n=11) and chest radiography ( n=14). In six patients unenhanced CT scans were available; in ten patients (2/10 patients had an unenhanced CT before) a contrast-enhanced CT was performed as an emergency investigation. In 5/14 patients additional oral contrast medium was given. Chest radiography revealed pleural effusions in 9/14 and infiltrates in 9/14 patients. Pneumothorax and pneumopericardium were observed in two patients each. Pneumomediastinum was seen in three patients. Two chest radiographs were normal. Esophagography performed in 11 patients demonstrated contrast medium extravasation at a supradiaphragmatic level in seven patients, indicating esophageal perforation with esophagopleural fistula, and a submucosal contrast medium collection in four cases. Unenhanced CT scans revealed four intramural hematomas with typical localization. Unenhanced and contrast-enhanced CT demonstrated periesophageal air collections indicating esophageal perforation in all patients. Pleural effusions were seen in 11/14 and infiltrates in 8/14 patients. Contrast medium extravasation was observed in 5/14 patients, whereas a thickening of the esophageal wall was depicted in 11/14 patients. Periaortic air tracks ( n=7), pneumothorax ( n=3), pneumomediastinum ( n=6), and mediastinal fluid collections ( n=7) were depicted in CT. By demonstrating periesophageal air tracks suggestive of esophageal perforation, CT reveals the decisive criteria for diagnosing Boerhaave's syndrome and should therefore be performed in the diagnostic work-up of patients in whom this syndrome is part of the differential diagnosis.
Journal Article↗
Temporary exclusion of the perforated esophagus using a linear vascular stapler: a new surgical treatment.
BACKGROUND/AIMS: A new technique using a linear staple suture for temporary exclusion of the perforated esophagus is presented. MATERIALS AND METHODS: The procedure is combined with diversion of esophageal fluid by nasogastric tube and drainage of the periesophageal compartments by silicon drains. A gastrostomy is used to drain the stomach for 48 hours, and later for enteral nutrition. Since the suture line reopens spontaneously after approximately 10 days there is no need of reoperation. RESULTS: This method allows diversion of esophageal fluids and therefore enhances effective healing of esophageal perforations after primary repair. Complete spontaneous recanalization of the esophagus occurs approximately two weeks after operation. CONCLUSIONS: The combination of primary repair of an esophageal perforation with esophageal exclusion by using a linear stapler and diversion of esophageal fluid contents by naso-esophageal tube and gastrostomy is a simple effective procedure. Further experience and studies may be needed to verify the usefulness and place of this technique in armamentarium of the visceral surgeon.
Aged↗
[Tension pneumothorax during removal of a foreign body from the esophagus].
Extracting foreign bodies from the esophagus is a common procedure in emergency rooms. We report the case of an 82-year-old man who came to the emergency room after swallowing a clam shell. After three successive examinations by fiberoptic endoscopy, the last of which was performed with general anesthesia, the patient suffered pneumomediastinum and pneumothorax first on the right side and then, within a few hours, on the left. After extraction of the foreign body, bilateral pleural drainage and emergency repair of esophageal perforation were required. Episodes of pneumothorax have been described after endoscopic procedures on the digestive tract such as esophagoscopy. The cause of esophageal perforation described may be iatrogenic, produced during esophageal manipulations or it may be caused by the foreign body itself, by an awake patient's performance of Valsalva maneuvers during esophagoscopy, or the entrance of air in the pleural cavity through esophageal perforation; any of these would explain the presentation of pneumothorax in this case. In the presence of sudden cardiorespiratory deterioration in a patient undergoing an endoscopic procedure, a diagnosis of tension pneumothorax must be considered.
Aged↗
[Transmural esophagus perforation. Experiences with conservative treatment].
We report on four cases of esophageal perforation - self-induced, iatrogenic and spontaneous (Boerhaave's syndrome) - treated successfully by conservative means. Based on our own experience and the data collected from the literature the clinical findings, symptoms and signs, prognosis and therapeutic guidelines are reviewed. As a general rule every esophageal perforation diagnosed within the first 24 hours should be treated surgically. After the 24-hour limit the mortality in both surgically and conservatively treated patients runs parallel. Conservative treatment is based on absolute exclusion of oral ingestion, broad-spectrum antibiotics and adequate drainage of pleural empyema and abscesses.
Adult↗
Surgical aspects of esophageal disease: perforation and caustic injury.
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Burns, Chemical↗
[Iatrogenic perforation of the esophagus].
Although advances in diagnostic methods and supportive therapy, mortality rates for esophageal perforation are still high. The most common cause of esophageal perforation is iatrogenic injury for the esophagus. In this article, causes, incidence, location of lesions, and treatment for iatrogenic perforation of the esophagus were reviewed.
Digestive System Surgical Procedures↗
Vascular injury following foreign body perforation of the esophagus. Review of the literature and report of a case.
Esophageal perforation resulting from foreign body ingestion is a rare occurrence. Most of the complications associated with this event, such as retroesophageal abscess, mediastinitis, pericarditis, pneumothorax, and pneumomediastinum, are widely recognized. However, little attention has been directed to the possibility of vascular injury caused by the perforating object. Isolated case reports have described significant morbidity and mortality subsequent to major vascular trauma resulting from an esophageal foreign body, usually emphasizing the presence of a "signal" hemorrhage from the gastrointestinal tract as a key to diagnosis. This report describes a case of esophageal perforation caused by an ingested fishbone that resulted in significant aerodigestive hemorrhage, possibly as the result of an unusual isolated vascular injury. The literature on vascular trauma following foreign body perforation of the esophagus is reviewed, and suggestions for the diagnosis and treatment of these dreaded complications are made.
Adult↗
[Instrumental perforation of the esophagus. Importance of diagnosis early in its clinical course].
Instrumental esophageal perforation is a serious complication that demands immediate therapy. In a retrospective study we have evaluated the results in seven patients treated for esophageal perforation by means of a conservative treatment without mortality. Instrumental dilatation of corrosive strictures were the most frequent cause of iatrogenic endoscopy. We have observed an esophageal injury associated with a Sengstaken-Blackemore tube placement. Clinical symptoms associated with chest roentgenograms guided to early diagnosis in all cases. Conservative treatment usually consist of a course of antibiotics, pleural drainage, and total parenteral nutrition. Clinical follow-up has been good in the seven patients treated.
Adolescent↗
[Classification and surgical treatment of intrathoracic esophageal injury caused by foreign body].
OBJECTIVE: To investigate the classification criterion and surgical treatment strategy of intrathoracic esophageal injury caused by foreign body. METHODS: Eighty-four patients with intrathoracic esophageal injury caused by foreign body in our department from January 1980 to April 2004 were divided into 4 grade: grade I was non-penetrated injury of esophagus (18 cases); grade II was esophageal perforation with mild mediastinitis (39 cases); grade III was esophageal perforation with severe intrathoracic infection (17 cases); grade IV was aortoesophageal fistula (10 cases). Based on the degree of esophageal injury and the extension of inflammation, operative procedures were selected including esophagotomy, esophageal reparation, esophagectomy, mediastinal drainage, reparation of fistula and replacement of aorta. RESULTS: Patients in grade I and II were all cured . One death occurred in grade III (1/17), the same in Grade IV was 9 (9/10). CONCLUSIONS: Classification of esophageal injury caused by foreign body is helpful to the decision of surgical treatment strategy. The prevention of aortoesophageal fistula is the key point of reducing of mortality.
Adolescent↗
Boerhaave's syndrome and barogenic injuries of the esophagus.
Herman Boerhaave clearly elucidated the pathology of barogenic esophageal perforation during the 18th century by describing the sad and fatal case of Baron John von Wassenauer. Although the science of the time had no treatment and surgery was considered a fool's venture, Boerhaave's description has stood the test of time and set the stage for modern surgical repair and treatment. The expeditious diagnosis, aggressive early repair, and vigilant attention to drainage of esophageal perforations in the 20th century all reduce the morbidity and are essential steps to obtaining the best outcome. Today, survival of barogenic esophageal perforation requires the surgeon to have the clarity of Boerhaave's observation of symptoms and to make use of modern surgical techniques to assure the patient's recovery from Boerhaave's syndrome.
Barotrauma↗