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At least 883 records · Page 49Linked to original sources
PubMed1998

Management of instrumental perforations of the esophagus occurring during treatment of corrosive strictures.

BACKGROUND: The initial symptoms of esophageal perforations (EP) may be subtle, but the progression is very rapid, and the outcome may be disastrous unless the diagnosis is made early and proper treatment is started immediately. METHODS: Between 1976 and 1996, 1,249 patients with caustic esophageal burns were treated at Ege University. The study group is composed of 52 patients with instrumental ER Perforations occured during dilatation attempts of esophageal strictures. Twelve patients were referred from other institutions after the occurrence of EP. RESULTS: In two patients, emergency surgical repair of the perforation was possible. Seventeen patients with unilateral and two patients with bilateral empyema were treated by pleural drainages. Anterior retrosternal mediastinal drainage was needed in one patient, and 11 patients required posterior mediastinal drainages. Three patients were treated by both anterior and posterior mediastinal drainage. Tracheoesophageal fistulas (TEF) developed in eight patients immediately after a dilatation attempt. Seven of these patients required esophageal replacement with colon to bypass the fistulas, and one patient in this group healed spontaneously. EP healed in 42.5 +/- 49.4 days. Twelve (23%) patients died of mediastinitis and sepsis. CONCLUSION: When EP is diagnosed and treated with these methods, the mortality rate should approach zero.

Burns, Chemical↗
PubMed1999

Perforated epiphrenic diverticulum treated by video laparoscopy.

We describe the case of an esophageal perforation that occurred after an endoscopic examination for epigastric pain 11 days before being referred to our institution. After 5 days of conservative management with total parenteral nutrition, left chest drainage, and broad-spectrum antibiotics, we decided to perform an videolaparoscopic jejunostomy for feeding with distal esophageal exclusion and a cervical esophagostomy. In the operating room, however, we found that the site of the perforation was an epiphrenic diverticulum. Treatment was diverticulectomy through videolaparoscopy with manual and mechanic suture. The postoperative evolution was successful, and the patient was discharged 8 days after surgery.

Diverticulum, Esophageal↗
PubMed2005

Spontaneous perforation in the ringed esophagus.

A 54-year-old man presented to the ER with chest pain. He underwent an upper endoscopy revealing a large linear esophageal tear and a CT chest showed free air in the mediastinum. He was managed conservatively and was discharged 2 days later. An UGI series revealed a distal esophageal stricture. He was commenced on esomeprazole for gastroesophageal reflux symptoms and his dysphagia improved significantly. Upper endoscopy revealed multiple rings throughout the esophagus. Biopsies from the distal and mid-esophagus were normal. The underlying pathophysiology, in patients with dysphagia and a ringed esophagus has evoked debate in the literature. Opinions range from underlying gastroesophageal reflux disease (GERD) to eosinophilic esophagitis (EE). Our patient's symptoms of GERD and dysphagia resolved with proton pump inhibitor therapy. Normal histology excluded underlying EE. There have been a few case reports of esophageal perforation in patients with a ringed esophagus, and underlying EE, but none with spontaneous perforation occurring in a 'ringed esophagus'. Perforations in the upper and mid-esophagus can usually be managed conservatively, while those in the distal esophagus often need surgery due to the high risk of developing mediastinitis. However, our patient, despite sustaining a large tear in the distal esophagus, did well with conservative management. This case demonstrates that spontaneous perforation in the ringed esophagus, with normal underlying histology can occur in the distal esophagus and may not require surgery.

Esophageal Perforation↗
PubMed2003

Use of large-diameter metallic stents to seal traumatic nonmalignant perforations of the esophagus.

BACKGROUND: Surgery for traumatic, non-malignant perforation of the esophagus in patients presenting more than 24 hours after its occurrence carries a high morbidity and mortality. Covered metallic stents have been used to effectively seal perforations in individual patients with Boerhaave's syndrome. METHODS: Eleven consecutive patients presented with esophageal perforation that was caused by Boerhaave's syndrome (n = 5), resection of an epiphrenic diverticulum (n = 2), rigid esophagoscopy (n = 2), extended gastric resection (n = 1), or pneumatic dilation for achalasia (n = 1). A large diameter Flamingo Wallstent (proximal/distal diameters, 30/20 mm) (7 patients) or a large diameter Ultraflex stent (proximal/distal diameters, 28/23 mm) (4 patients) was placed. Pleural cavities were drained with thoracostomy drains, and antibiotics were administered. RESULTS: The median time from perforation to stent insertion was 60 hours (range, 24 hours to 28 days). The perforation was totally sealed in 10 of 11 patients. Two patients underwent esophageal resection because of incomplete sealing of the perforation or incomplete drainage of the pleural cavity and mediastinum. The other 9 patients recovered uneventfully and resumed a normal diet within 7 to 18 days. In 7 patients, the stents were retrieved endoscopically after a median of 7 weeks (range, 6 to 14 weeks), whereas two patients refused to have the stent retrieved (in one, the stent migrated into the stomach; the other patient died 6 months after stent placement from an unrelated cause). CONCLUSIONS: Traumatic perforation of the esophagus can be treated successfully with large diameter metallic stents, together with adequate drainage of the thoracic cavity.

Adult↗
PubMed1977

Complications and failings of the combined Collis-Belsey operation.

Eighty-three patients with risk factors predisposing to recurrent reflux after standard hiatal hernia repairs have undergone the Collis-Belsey operation. There were two postoperative deaths. Complications related to multiple operations on the lower esophagus included injury to the spleen (three patients); gastrocutaneous fistula (two patients), and localized ischemic necrosis of esophagus two patients). There were two esophageal perforations. In four of 15 patients, the combination of esophagomyotomy and the Collis-Belsey operation produced functional esophageal obstruction. Three patients have experienced late major lower esophageal bleeding from ulceration of mucosa adjacent to the gastroplasty tube; two the these patients have no demonstrable gastroesophageal reflux. In addition to postoperative interviews and barium swallows, 77 patients have been evaluated with esophageal manometry and acid reflux testing. After an average follow-up of 12 montsh, 19 percent have symptomatic reflux, but 30 percent have moderate-to-severe reflux with pH reflux testing. The recent enthusiasm for the combined Collis-Belsey operation should be tempered by continued, cautious, objective assessment of its long-term results.

Adolescent↗
PubMed2006

Analysis of 59 ERCP lawsuits; mainly about indications.

BACKGROUND: This study reports the analysis of a personal series of 59 cases in which ERCP malpractice was alleged. METHODS: Half of the cases involved pancreatitis; 16 suffered perforation after sphincterotomy (8 of which involved pre-cutting), and 10 had severe biliary infection. There were 2 esophageal perforations. Fifteen of the patients died. The most common allegation (54% of cases) was that the ERCP, or the therapeutic procedure, was not indicated. Most of these patients had pain only, usually after cholecystectomy. Negligent performance was alleged in 19 cases, with corroborating evidence in 8. Inadequate postprocedure care was alleged in 5 cases, including 3 with a delayed diagnosis of perforation. Disputes about the extent of the education and consent process were common. RESULTS: The final outcome was available in 40 cases. Sixteen were withdrawn, and 14 were settled. Of the 10 that came to trial, half were defense verdicts. CONCLUSIONS: The lessons are clear. ERCP should be done for good indications, by trained endoscopists with standard techniques, with good documented patient informed consent and communication before and after the procedure. Speculative ERCP, sphincterotomy, and pre-cuts are high-risk for patients and for practitioners.

Bile Duct Diseases↗
PubMed1997

[Perforation of the cervical esophagus after ventral fusion of the cervical spine. Defect coverage by muscle-plasty with the sternocleidomastoid muscle: case report and review of the literature].

The therapy for spontaneous or artificial perforation of the esophagus remains a controversial matter. The following case report deals with the medical history of an artificial esophageal perforation after operative treatment of cervical disc disease. A 68-year-old male patient underwent a C4/C5 and C5/C6 discectomy with interbody fusion of C7-T1 vertebral body, according to Smith-Robinson. During this operation, a 3-cm-long lesion was made in the posterior wall of the esophagus, which was treated 24 h later with a primary suture. The clinical follow-up was complicated by mediastinitis with subsequent multiorgan failure. After recovery from this critical condition the patient dysphagia, which was related to a persistent lesion in the posterior esophageal wall with endoscopically demonstrated dislocation of a screw. After removal of the screw, the lesion was covered by means of sternocleidomastoid myoplasty. Moderate postoperative dysphagia was successfully treated by bougienage.

Aged↗
PubMed1993

[The value of conservative therapy, surgical treatment and interventional radiology in perforations and ruptures of the esophagus].

We have reviewed all the records of 23 patients hospitalized in our institution from January 1981 till December 1991 and presenting a confirmed diagnosis of esophageal perforation. We have studied the aetiology, the localization, morbidity and mortality and we discuss the therapeutic management. 9 patients presented a cervical perforation, 13 patients a thoracic perforation and 1 patient an abdominal perforation. Among the patients with cervical perforation 2 patients had a local revision with drainage, 3 patients a primary suture and 4 patients were treated conservatively. No complication was found in this group. The patients with thoracic perforation have been treated as follow: 3 conservatively, 8 with thoracotomy, primary suture +/- patch, drainage, 2 patients with thoracotomy and drainage alone. All complications happened in this group: 2 gastro-intestinal bleeding, 2 ARDS, 3 mediastinitis, 1 pneumonia. 2 patients in a very poor general condition died, one with a metastatic breast carcinoma, the other after a CVI with a massive gastro-intestinal bleeding. The cervical perforations have an excellent prognosis and can be treated conservatively if they are asymptomatic and do not display a pleural lesion. The thoracic perforations can be treated surgically if they are diagnosed early before septic complications. If not, they will be better treated conservatively with drainage. The intraabdominal perforations have to be treated as every intraabdominal perforation. In this case, we perform a primary suture completed with fundoplication.

Aged↗
PubMed1992

Temporary double exclusion of the perforated esophagus using absorbable staples.

A new method for double exclusion of the esophagus is presented. Temporary closure of the cervical and intraabdominal esophagus using absorbable staples allows effective healing of esophageal perforations. The procedure should be routinely combined with drainage of the periesophageal abscess. Complete recanalization of the esophagus occurs 1 to 2 weeks after operation.

Adolescent↗
PubMed1975

Pharyngeal pseudodiverticulum in an adult.

Posterior perforation of the cervical portion of the esophagus may present deceptive clinical and roentgenographic pictures. In the neonate, the clinical picture resembles that of esophageal atresia; in the adult, the roentgenographic appearance may resemble Zenker diverticulum. In either instance, treatment should be no different from that employed for more commonplace esophageal perforations, namely, prompt, aggressive surgical intervention.

Accidents, Home↗
PubMed1982

Management of esophageal and pharyngeal perforation in the newborn infant.

Perforation of the esophagus or pharynx may occur during placement of endotracheal or nasogastric tubes in the newborn infant. Controversy exists, however, whether medical or surgical therapy is better in the management of these perforations. Nine patients who had esophageal or pharyngeal perforation in the neonatal period and were treated medically with antibiotics, nutritional support, and closed chest-tube drainage of pneumothoraces are described. All perforations healed without surgical repair. No mortality or morbidity occurred secondary to these perforations. This study, together with a review of the 73 patients described in the literature, indicate that perforations of the pharynx and esophagus can be satisfactorily managed medically. There is no apparent advantage to routine early surgical exploration. Only complications such as mediastinitis and mediastinal mass formation seem to require surgical treatment. Medical therapy with close observation for signs of sepsis and/or mediastinal changes will enable most newborn infants to avoid an operation and will identify those infants for whom surgery is definitely indicated.

Ampicillin↗
PubMed1983

A "wandering bullet" in the thoracic esophagus.

This paper describes a patient with a perforation of the thoracic esophagus that was not recognized for 30 hours. Curiously, this patient did well without surgical intervention. Therapeutic considerations for thoracic and cervical esophageal perforations are discusses.

Adolescent↗
PubMed1975

Esophageal injury.

This review considers all possible modes of esophageal injury, based on a schema originally published in 1954 and more recently modified in 1970. For each category of injury there are detailed discussions of diagnosis and treatment. The best available knowledge of present-day modalities has been based on a survey of the literature for the past decade. When diverse methods of treatment were encountered, we have made comments consistent with our personal experience, when appropriate. The medicolegal literature contains a number of references to esophaegeal injury. Certain excerpts dealing with several types of potential actions are extracted: (1) suits to recover damages for esophageal perforation in which negligent endoscopy was claimed; (2) suits following endoscopic accidents in which lack of informed consent was claimed; and (3) suits for professional liability based on misdiagnosis, delayed diagnosis, or wrong treatment of esophaegeal perforation.

Alcohol Drinking↗
PubMed1983

Successful treatment of primary aorta-esophageal fistula resulting from aortic aneurysm.

Most aneurysms of the descending thoracic aorta rupture unless treated surgically. Autopsy studies in these patients indicate that rupture occurs into the esophagus in 10% of the cases and constitutes the most common cause of aorta-esophageal fistula. A reasonable literature review has not revealed a previously successful treatment for this condition. Experience in the treatment of patients with aneurysms of the descending thoracic aorta partially obstructing the esophagus without fistula formation indicates that simple graft replacement is curative. When the disease has progressed to actual fistula formation and esophageal bleeding, as illustrated in these two case reports, operation is done to prevent exsanguination. Appropriate management involves control of hemorrhage and treatment of the chronic esophageal perforation. The former is accomplished by resection and graft replacement of the ruptured thoracic aneurysm. Alternatives in dealing with the chronic esophageal defect are planned, staged reconstruction in high-risk patients and immediate resection and intrathoracic esophagogastrostomy in selected patients.

Aged↗
PubMed2006

Pericardial sac perforation: a rare complication of neonatal nasogastric tube feeding.

The insertion of a nasogastric tube for feeding and gastric aspiration is a common practice in the care of newborns, especially if they are preterm and unwell. Esophageal perforation is a rare but serious complication of this procedure. Associated perforation of the pericardial sac is an unusual, severe, and previously unreported complication of nasogastric tube feeding in a neonate. We present an illustrative case.

Contrast Media↗
PubMed1997

Esophageal atresia/tracheoesophageal fistula and associated congenital esophageal stenosis.

BACKGROUND: The association of congenital stenosis of the distal esophagus (CES) in children with esophageal atresia/tracheoesophageal fistula complex (TEF) has been described but is thought to be rare. Most reports have been of individual or small numbers of cases. OBJECTIVE: The objective of the study was to evaluate the incidence, clinical and radiographic features of CES associated with TEF, and to compare the clinical and radiographic features of CES with acquired anastomotic strictures in TEF patients. MATERIALS AND METHODS: A retrospective review was undertaken of the records and radiographs of 225 infants with primary TEF repair over a 26-year period. RESULTS: A total of 18 of 225 (8 %) cases of CES associated with TEF and 43 of 225 (19 %) cases of anastomotic strictures were identified. CES was typically a relatively long, smooth circumferential narrowing at the junction of the mid-esophagus and distal esophagus, with normal-caliber esophagus above and below; anastomotic strictures, in contrast, were focal. Diagnosis of CES was delayed in 10 cases and missed on one or more fluoroscopic studies in 14 children. Symptoms, including feeding and respiratory problems and foreign body impaction, were common in both CES and anastomotic strictures; repeated esophageal dilatations were usually necessary. Esophageal perforation complicated dilatation in 6 (33 %) young children with CES, but none of the children with anastomotic strictures (P < 0.001). CONCLUSION: CES in combination with TEF is not rare and usually produces clinical symptoms. The diagnosis may be missed or delayed unless specifically evaluated surgically and radiologically. Esophageal dilatation in CES is potentially hazardous with a high risk of perforation, especially in young children.

Dilatation↗
PubMed1994

Atypical presentation of spontaneous pneumomediastinum.

Spontaneous pneumomediastinum is a rare clinical entity; when diagnosis is certain, no treatment is required and symptoms rarely recur. The clinical presentation is usually diagnostic; however, atypical symptoms may mandate further investigation before diagnosis can be established. We describe 2 patients with spontaneous pneumomediastinum who presented with dominant esophageal symptoms (odynophagia and dysphagia) suggestive of esophageal perforation. Investigation and management are discussed.

Adolescent↗
PubMed1984

Severe esophageal strictures: indications for balloon catheter dilatation.

Bougienage of esophageal strictures is a traditional method of therapy for patients who present with a stricture sufficiently large to permit passage of a mercury-weighted rubber bougie. However, when the residual lumen is smaller than 12 mm diameter, bougie dilatation acquires a prohibitively high risk of esophageal perforation. Twenty patients who had severe esophageal strictures have undergone surgical repair or Eder-Puestow dilatation assisted by guidewire. Fluoroscopic balloon catheter dilatation obviated surgery and allowed subsequent standard bougienage both in hospital and at home performed by the patient. We discuss indications, technique, results, and complications.

Angioplasty, Balloon↗