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PubMed1976

Gunshot wounds of the esophagus.

During a 4 year period between 1970 and 1974 there were eleven esophageal gunshot wounds representing 52 per cent of the total esophageal perforations. The increased incidence of esophageal gunshot wounds reflects the higher rate of civilian gunshot injuries. There were six perforations in the cervical portion of the esophagus and five in the thoracic portion, with three located above the aortic arch, one in the midesophagus, and one in the lower third. Symptoms are less diagnostic than in esophageal perforations from other causes because the gunshot wound tends to mask the complaints related to mediastinitis. The signs are similar. In 9 patients free air was present in the neck or mediastinum and in 10 patients the diagnosis was confirmed by barium swallow. Of the 2 patients without free air, one had a lateral thoracic wound and esophageal injury was not suspected; the diagnosis was made by drainage of oral feeding through a thoracostomy and confirmed by barium swallow. In the other patient the perforation was found during surgery for hemothorax. Primary repair with drainage was done in the group with cervical injuries. All survived with no serious complications. In the group with thoracic injuries, fistulas developed in 2 of 3 patients who had primary repair with drainage. Two patients with extensive injuries of the esophagus treated by defunctionalization did well but required a second procedure. It is concluded that gunshot wounds of the cervical esophagus, if treated promptly by suture and drainage, will do well. Thoracic injuries represent a more difficult problem and it is suggested that defunctionalization of the esophagus is the safest procedure, particularly if damage is extensive.

Abscess↗
PubMed2003

Esophageal foreign body causing direct aortic injury.

Foreign bodies in the esophagus are uncommon causes of esophageal perforation. Many nonperforating cases are successfully managed by flexible gastroscopy. However, complicated foreign bodies such as those that result in esophageal perforation and vascular injury are best managed surgically. Gastroscopy remains the primary method of diagnosis. A case of a 59-year-old woman who developed retrosternal and intrascapular pain, odynophagia and hematemesis after eating fish is reported. Flexible gastroscopy showed arterial bleeding from the midthoracic esophagus. Computed tomography scan localized a 3 cm fish bone perforating the esophagus with surrounding hematoma. An aortogram did not reveal an actively bleeding aortoesophageal fistula. The fish bone was surgically removed and the patient recovered with no postoperative complications. This case illustrates the importance of early consideration for surgical intervention when confronted with a brisk arterial bleed from the esophagus with suggestive history of foreign body ingestion.

Aorta↗
PubMed2006

Primary repair of an esophageal rupture using pleural flap.

Esophageal perforation remains an important thoracic emergency. Aggressive operative therapy remains the mainstay for treatment. A case of esophageal perforation, consequent upon impacted food bolus, is presented. An 80 years old female, with multiple comorbidities, presented with dysphagia and right sided chest pain, who had a distal esophageal tear, secondary to accidental meat ball ingestion. Rigid esophagoscopy showed complete occlusion of the distal esophagus with a meat ball. Right thoracotomy was performed, which showed perforated esophagus with large meat ball protruding from it. Endoscopic removal of the food particles was done, and the rupture was repaired using a pleural flap. The entire postoperative stay was uneventful and the patient was discharged on the ninth post-operative day.

Aged↗
PubMed2005

[Thoracoscopy and intraoperative upper gastrointestinal endoscopy was effective for Boerhaave syndrome; report of a case].

Boerhaave syndrome is a rare disease and needs an exact diagnosis and a proper treatment plan because of its terrible clinical course. We experienced a case of Boerhaave syndrome that thoracoscopy and intraoperative upper gastrointestinal (GI) endoscopy was very effective. Sixty-four-year-old man realized chest and back pain after vomitting. Esophageal perforation was suspected, but 64 hours had passed already when we started a surgical treatment. By the thoracoscopy and intraoperative endoscopy, lower esophageal perforation and infectious pleural effusion were found. Therefore, we selected a surgical treatment under the assistance of thoracoscopy. Secondly, a simple closure and intracostal muscle overlapping was performed with small incisional thoracotomy. Postoperative complication, such as mediastinal abscess, has not occurred. Thoracoscopy and intraoperative upper GI endoscopy was effective for an appropriate diagnosis and treatment of Boerhaave syndrome.

Endoscopy, Gastrointestinal↗
PubMed1979

Desirability of roentgen esophageal examination immediately after pneumatic dilatation for achalasia.

Although infrequent, esophageal rupture is a serious complication of pneumatic dilatation for the treatment of achalasia. Because of an experience with delayed recognition of esophageal perforation in a patient with achalasia, we now examine the esophagus using a water-soluble contrast medium immediately following every pneumatic dilatation. This technique allows immediate detection of esophageal perforation.

Adult↗
PubMed1986

[Perforations of the esophagus].

The prognosis of esophageal perforations remains poor. In this study 80 cases (26 cervical, 45 thoracic and 9 abdominal) are reported. Pain was the most frequent symptom, present in 56/80 cases. Signs of perforation were detected on standard X-ray films in 85% of the cases, and oesophagography with Hytrast showed a leak in 88%. Treatment was delayed for more than 24 hours in 41 patients. Direct intervention on the esophageal wound (suture, fistulization, drainage, double exclusion, resection) was carried out in 54 patients, whereas 26 were fed parenterally or by tube or through jejunostomy and were given antibiotics with or without drainage of a fluid collection. The overall mortality rate was 35%, death being caused by infection or toxic shock. Treatment and prognosis were dependent upon the course of the infection. No other single prognostic factor was significant, with the exception of age over 60.

Esophageal Perforation↗
PubMed1998

Restoration of the normal squamous lining in Barrett's esophagus by argon beam plasma coagulation.

OBJECTIVE: Barrett's esophagus is associated with significantly increased risk of development of esophageal adenocarcinoma. Replacing columnar epithelium with the normal squamous lining in this condition offers the possibility of decreasing the risk of degeneration to invasive adenocarcinoma. This study aimed to establish the feasibility of argon beam plasma coagulation (ABPC), in conjunction with control of gastroesophageal reflux, to restore the squamous lining. METHODS: Thirty patients with Barrett's esophagus (four low-grade dysplasia, three high-grade) were recruited from our surveillance program, and underwent endoscopic ABPC. RESULTS: Twenty-seven patients completed treatment, with macroscopic replacement of their columnar lining by squamous epithelium, histologically confirmed in all 27, and followed up for a median of 9 months (range, 6-18 months). Two patterns of squamous replacement were identified: 70% of patients showed squamous epithelium with no persistent intestinal metaplasia, and in 30% the new squamous epithelium covered areas of underlying intestinal metaplasia. One patient has withdrawn from the study. Two esophageal perforations, with one death, occurred early in the study. CONCLUSION: ABPC, in conjunction with control of gastroesophageal reflux, allows squamous regrowth in both benign and dysplastic Barrett's esophagus. Despite the theoretical safety advantages of ABPC over techniques such as laser, esophageal perforation may occur with this technique. It is too soon to recommend ABPC for dysplastic or nondysplastic Barrett's because follow-up is too short to show a decreased incidence of and mortality from adenocarcinoma.

Adenocarcinoma↗
PubMed2002

Esophageal foreign bodies: a Jordanian experience.

OBJECTIVES: To study the pattern of esophageal foreign bodies (FB) in Jordan and to compare it with other countries. METHODS: This is a retrospective study conducted on all patients (527) who were admitted with esophageal FB during a period of 9 years from January 1992 to January 2000. Two major referral hospitals were involved: the Princess Basma and Al-Bashir hospitals. A data sheet was constructed in which we included: name, age, gender, presenting symptoms, type and site of FB, technique of removal, and complications if present. RESULTS: Of the 527 patients 53% were male and 47% were female.77% were children under the age of 10 years. In children coins were by far the most common FB to be found in the esophagus (68%), while bones were the principal FB to be found in adults (8%). In 89%, the FB was found at the level of cricopharyngeal muscle. Drooling of saliva (72%), dysphagia (71%), and vomiting (24%) were the most commonly presenting symptoms. Both rigid esophagoscopy and Magill forceps techniques were used to remove the FB from the esophagus. The complication rate was 2% which included: esophageal perforation and mediastinitis, esophageal stenosis and esophageal erosions. CONCLUSION: The pattern of esophageal FB in Jordan is not different from other countries.

Adolescent↗
PubMedDate not supplied

Piriform sinus perforation during Esophageal-Tracheal Combitube placement.

The Esophageal-Tracheal Combitube is a new alternative airway device. Few complications of its use have been reported. This article reports a case of a 71-year-old female with angioedema of the tongue and airway obstruction who suffered piriform sinus rupture during Combitube placement by prehospital personnel, resulting in massive subcutaneous emphysema. Caution is required when using this device in all but the most controlled situations.

Aged↗
PubMed2003

Esophageal tear: an unusual complication after difficult endotracheal intubation.

Esophageal perforation is a serious life threatening injury that may occur during inadvertent esophageal intubation. We report two cases of iatrogenic esophageal perforation after attempted endotracheal intubation. Our experience confirms that early diagnosis (as in the first case) is associated with a more favorable outcome. Therefore, a high index of suspicion is required for early diagnosis of this complication because the symptoms are often nonspecific and may be delayed.

Aged↗
PubMed1986

Vertical banded gastroplasty: results in 233 patients.

The authors describe their experience with vertical banded gastroplasty in 233 patients for whom the follow-up ranged from 12 to 30 months. There were no deaths. Intraoperatively, two gastric perforations and one esophageal perforation occurred; these were closed and drained. A postoperative leak was treated promptly by removal of the collar, drainage and gastrostomy. There were three instances of late obstruction, due in one to mesh adhering to liver and in two to stenoses; gastrogastrostomy was followed by regained weight. Removal of the collar was also associated with failure to lose adequate weight. Rare complications were intraluminal erosion of mesh and staple-line breakdown. The gallbladder was still present in 175 patients; of these, 25 had gallstones and underwent a cholecystectomy at the time of gastroplasty. Of the other 150, symptomatic gallstones subsequently developed in 13. At 12 months after gastroplasty 80% of patients had lost at least 50% of excess weight and at 24 months 83% had lost 50% or more of excess weight (15 patients lost to follow-up). To avoid failures, the collar circumference should not be more than 5.0 cm. A small experience suggests that revision of a failed horizontal gastroplasty to vertical banded gastroplasty is hazardous.

Adolescent↗
PubMed1979

[Perforation of the esophagus. A review of 12 cases (author's transl)].

Perforation of the esophagus is a very serious condition which is nearly always fatal, unless it can be diagnosed and treated at the earliest possible moment. Ten thousand case histories in a Department of Internal Medicine and a Department of Surgery were reviewed, among which 12 cases of esophageal perforation were found. The overall mortality in this series was 59 percent; the mortality of the surgically treated group was 39 percent. Four of the five patients operated on within the first 24 hours survived. The prognosis was poor when the lower third of the esophagus was ruptured. Esophageal perforations are becoming increasingly more frequent because of the widespread practice of endoscopy. The clinical symptoms of the condition include subcutaneous emphysema, retrosternal pain and dispnea. X-rays often show air or fluid in the mediastinum, air and fluid in the pleural space, and evidence of rupture when opaque contrast material is employed. These signs should usually by sufficient for an early diagnosis. Surgery is the treatment of choice.

Adult↗
PubMed2001

Esophageal laceration and charcoal mediastinum complicating gastric lavage.

A 19-year-old woman underwent multiple attempts at orogastric lavage before success 5 h after ingesting approximately 24 grams of ibuprofen in a suicide attempt. Activated charcoal was administered via the lavage tube. She vomited charcoal shortly after administration and began experiencing difficulty breathing and an increase in the pitch of her voice. A chest X-ray study showed a widened mediastinum, pneumopericardium, and subcutaneous emphysema consistent with esophageal perforation that was confirmed by computed tomography scan. Surgical exploration revealed a tear in the proximal posterior esophagus with charcoal in the posterior mediastinum. She remained intubated for 7 days and was discharged 14 days after admission. This is a report of esophageal perforation with activated charcoal contamination of the mediastinum after gastric lavage. The risks and benefits of this procedure should be carefully considered in each patient prior to its use. Awake patients should be cooperative with the procedure to minimize any risk of trauma to the oropharynx or esophagus.

Adult↗