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At least 919 records · Page 51Linked to original sources
PubMed1988

Physiologic exclusion of the injured esophagus.

Despite continuing advances in the surgical and nutritional management of esophageal perforation, morbidity and mortality remain significant. Described within is the successful management of two such cases by the physiologic exclusion of the esophagus. By this, we mean distal decompression and proximal diversion and decompression through a gastrostomy and cervical esophagostomy. This provides the greatest chance for protection of the esophageal suture line repair.

Aged↗
PubMed2003

Management of oesophageal perforation after delayed diagnosis: the merit of tissue flap reinforcement.

Oesophageal perforation remains a life-threatening situation and its management represents a challenge for the surgeon, especially if diagnosis has been delayed. In most cases, a surgical approach is indicated. Simple primary repair often result in leakage. In order to avoid leakage, the primary repair should be buttressed with some kind of tissue flap. We here report our experience with 15 esophageal perforations and 10 tissue flap reinforcements performed during the last decade. The different types of tissue flap are illustrated and their results are compared with more aggressive alternatives such as oesophagectomy, T-tube drainage and oesophageal exclusion.

Adolescent↗
PubMed2004

Esophageal diverticula: current classification and important complications.

Esophageal diverticula, although often asymptomatic or discovered incidentally during the workup of unrelated symptoms, may serve as a sign to clinicians of an ongoing dysmotility process involving the esophagus, particularly in our aging population. As well, esophageal diverticula may lead to unexpected complications as a result of instrumentation such as endoscopy or nasogastric tube placement that may result in significant morbidity and mortality including esophageal perforation. This article discusses these topics in detail with special emphasis on radiologic diagnosis and information for clinicians for management and avoidance of potentially serious complications.

Aging↗
PubMed1990

Radiation-induced esophageal injury: a spectrum from esophagitis to cancer.

Radiation esophagitis is a common but frequently unrecognized complication of therapeutic radiation to the neck, chest, or mediastinum. The spectrum of injury ranges from acute self-limited esophagitis to life-threatening esophageal perforation. Complications such as stricture or primary esophageal cancer may occur many years after irradiation, and their linkage to radiation may not be considered. Five cases of radiation-induced injury are described, and the spectrum of radiation-induced esophageal injury is reviewed.

Aged↗
PubMed1998

[Treatment of cicatricial esophageal strictures and esophageal anastomoses by using flexible endoscopes].

The paper presents the results of endoscopic treatment of benign esophageal strictures of various origin in 294 patients and of scar stenosis of esophageal anastomoses in 157 patients. The basic endoscopic techniques of expansion are balloon hydrodilatation by using catheters, 10-30 mm in diameter and bouginage of Savary's (maximum outside diameter 40 Fr) and Eder-Puestow's (with olives, 15-20 mm in diameter) bougies. Good and excellent direct results were obtained in 57.1% of patients with esophageal strictures and in 87.8% of patients with stenoses of digestive anastomoses. Esophageal perforation occurred in 1.03% of patients with esophageal strictures. There were no serious complications after endoscopic treatment of postoperative stenoses. To prevent restenoses, endoscopic treatment should include regular outpatient maintaining dilatations by using dilatators at longer intervals during 3-6 months.

Anastomosis, Surgical↗
PubMedDate not supplied

Retropharyngeal abscess in the adult.

Retropharyngeal and prevertebral abscesses, although uncommon, present a perplexing diagnostic and therapeutic problem. In the adult, the disease is less common than in the child, but its etiology may be more diverse. Four cases of retropharyngeal or prevertebral abscesses in the adult are presented, resulting from (1) endotracheal intubation trauma, (2) esophageal perforation, (3) tuberculosis of the cervical spine, and (4) coccidioidomycosis. The pathophysiologic conditions and pertinent anatomy are discussed in relation to the medical and surgical approach to these lesions.

Abscess↗
PubMed1993

[Endoscopic and surgical removal of foreign bodies from the upper gastrointestinal tract].

Results of management of 67 patients who swallowed foreign bodies are discussed. Types of foreign bodies, the importance of previous esophageal strictures, the rare diagnostic difficulties and the different clinical signs are analyzed. Authors stress that the most frequent causes of the artificial esophageal perforation are the endoscopic removal of swallowed foreign bodies. A surgical intervention in 14 cases was necessary. Three patients were lost after the surgical intervention.

Adolescent↗
PubMed2000

[Boerhaave syndrome. A case report and review of the literature].

Spontaneous esophageal perforation (Boerhaave's syndrome) remains a difficult diagnostic and management problem with controversial recommendations regarding its treatment. The clinical manifestations of the disease are variable, and may be misleading, thus delaying accurate recognition. On the other hand, in view of the rapid onset of severe complications, particularly mediastinitis, a prompt diagnosis is essential to a better prognosis, successful operative outcome and potential survival. A case of spontaneous perforation of the thoracic esophagus penetrating the left pleural space treated within 4 hours from admission to the Emergency Room, with minimal surgical intervention is presented. Despite negative chest X-ray, a thoracic TC showed a small right sided effusion with left sided hydropneumothorax, and the definitive diagnosis was obtained by contrast study with a water soluble medium which showed the leak communicating freely with the left pleural space. The patient underwent repair by thoracic approach, the rupture was closed with a primary suture without flap reinforcement and the pleural space drained with the placement of single chest thoracostomy tube. The recovery was uneventful. The analysis of this case report and of the appropriate literature reveals that a poor prognosis is correlated with the time elapsed between the perforation and treatment. In conclusion the importance of an early aggressive surgical treatment for the Boerhaave's syndrome is emphasized, because any perforation treated more than 24 hours after the onset of symptoms, irrespective of the procedure used, is associated with a significantly higher morbility and mortality.

Aged↗
PubMed1995

Conversions and complications of laparoscopic treatment of gastroesophageal reflux disease. Formation for the Development of Laparoscopic Surgery for Gastroesophageal Reflux Disease Group.

BACKGROUND: It is now known that laparoscopic surgery is associated with less discomfort and less pain during the patient's postoperative course. Laparoscopic treatment of gastroesophageal reflux disease (GERD) is technically feasible. The advantages of this minimally invasive surgical route seem well adapted to a basically functional surgery. However, it is important to know whether laparoscopic access adds a specific risk to this type of surgery. PATIENTS AND METHODS: A retrospective survey was conducted among members of the Formation for the Development of Laparoscopic Surgery (FDCL) group during 1993. A form was filled in anonymously for each patient who had had either a conversion or a postoperative complication following a laparoscopic procedure for GERD. Items concerned preoperative workup, technical details of surgery, and postoperative course. Another form was used to ascertain how many surgical procedures for GERD had been performed during the same period, either laparoscopically or via an elective laparotomy. Nineteen surgeons from the FDCL group took part in the study. From 1991 to 1993, 758 patients underwent a laparoscopic procedure for GERD, while during the same period 38 patients underwent an elective laparotomy. RESULTS: In the laparoscopic group, there were 294 Nissen, 334 Nissen-Rossetti, and 106 Toupet procedures, and 24 Angelchik prosthesis placements. No deaths occurred. The operation had to be converted to an open procedure in 32 cases (4.2% conversion rate). In 7 cases the conversion was due to an intraoperative complication, whereas in 25 cases the conversion was done because of technical difficulties. In 6 cases an intraoperative complication was treated laparoscopically without conversion. Thirty post-operative complications were recorded (morbidity 4%), leading to a reoperation in 12 cases. Five major complications were observed: 2 esophageal perforations, 2 gastric perforations, and 1 bowel perforation. CONCLUSION: These results compare favorably with those of open surgery and suggest that laparoscopic treatment of GERD is as safe as open surgery when performed by a surgeon experienced in laparoscopy.

Chi-Square Distribution↗
PubMed2003

Mediastinitis complicating a percutaneous endoscopic gastrostomy: a case report.

BACKGROUND: Since its introduction in the early 1980s, percutaneous endoscopic gastrostomy has become the most popular method for performing a gastrostomy for long-term enteral feeding. It has been associated, however, with a lot of minor and major complications. CASE PRESENTATION: A case of mediastinitis with concominant sepsis caused by a masked esophageal perforation after percutaneous endoscopic gastrostomy in a multi-traumatized, brain-injured patient is presented. Ten - fourteen days after the procedure, the patient became febrile and gradually septic with tenderness of the sternum and upper abdomen. Computerized tomography of the thorax revealed mediastinitis. An urgent left thoracotomy and laparotomy were performed for drainage of the mediastinum, removal of the gastrostomy and insertion of a jejunostomy tube. The patient improved soon after the surgery. He was successfully weaned off the ventilator and was discharged from the Intensive Care Unit. CONCLUSION: Perforating mediastinitis is a rare but potentially lethal complication of percutaneous endoscopic gastrostomy. When diagnosed and properly treated it may have a favourable outcome.

Accidents, Traffic↗
PubMed2004

The missing hazelnut.

This report describes a case of esophageal perforation caused by a hazelnut which became stuck in the upper esophagus but was not detected. We outline the pitfalls in diagnosis, complications and treatment in the pediatric population.

Airway Obstruction↗
PubMed2003

Is same-day discharge suitable following rigid esophagoscopy? Findings in a series of 655 cases.

It has been suggested that more otolaryngologic procedures should be performed on an outpatient basis, and that rigid upper aerodigestive tract endoscopy might be a particularly suitable procedure in this regard. To determine if this is indeed the case, we retrospectively reviewed the records of 563 patients who had undergone 655 rigid esophagoscopies in our unit between Jan 1, 1991, and July 31, 1998. We ascertained the rate of complications (primarily esophageal perforation) following such procedures and, when they did occur, we determined the length of time between surgery and the onset of the complications' signs and symptoms. Our aims were to establish the minimum duration of postoperative observation that is required following esophagoscopy and to propose criteria for safe same-day discharge. We found that perforation rates were 4.5% following therapeutic procedures (dilation, biopsy, and foreign-body removal) and 1.2% following diagnostic procedures. In 40% of the patients who experienced perforations, no such signs or symptoms were noted within the first 8 hours following surgery. This finding has important implications for surgeons who wish to perform rigid esophagoscopy on an outpatient basis.

Adolescent↗
PubMed1993

Esophageal-aortic erosion associated with double aortic arch and tracheomalacia. Experience with 2 infants.

Patients with double aortic arch may require lengthy intubation for ventilatory support. The need for endotracheal and nasogastric intubation may be prolonged in such patients because of associated tracheomalacia. Iatrogenic tracheal or esophageal erosion with subsequent aortic fistulization is an unusual but catastrophic complication that may result from such intubation. We report the cases of 2 infants with double aortic arch and tracheomalacia who developed iatrogenic esophageal-aortic erosion. This complication was successfully managed in 1 of the infants. We conclude from our experience that the important steps in preventing this complication include 1) expediting the exclusion of upper-airway compromise in intubated infants who have a presentation characteristic of bronchospastic airway disease (hyperinflation and hypercapnia) that seems unresponsive to usual therapeutic measures; and 2) expediting the diagnosis of vascular ring in order to minimize the duration of dual tracheal and esophageal intubation. Effective management of this problem, once established, requires primary closure of the esophageal perforation, removal of the nasogastric tube, interposition of thick viable tissue between the esophagus and the aorta, and decompressive gastrostomy and feeding jejunostomy. Concomitant aortopexy may be appropriate.

Aorta, Thoracic↗
PubMed2004

Chronic retained foreign bodies in the esophagus.

Two cases of esophageal perforations consequent upon chronic retained foreign bodies are presented. In both patients a mediastinal mass associated with the foreign body was noted on chest radiography. Retrieval of the foreign bodies, although feasible by esophagoscopy in 1 patient, was unsuccessful in the second patient, thus necessitating thoracotomy.

Child↗
PubMed1989

[Complications of endoscopic examinations of the upper segments of the gastrointestinal tract].

A ten-year experience with 106610 diagnostic esophagogastroduodenoscopies provided evidence of a 0.03% rate of relevant complications and 2.38% mortality. Out of 39 patients with endoscopy-related complications 5 were operated on: 4 had esophageal perforations, 1 had hemorrhage following biopsy of the ulcer. Out of 7384 therapeutic and operative endoscopies none were associated with lethal outcome. Surgery was avoided either. Complications developed in 45 patients (0.036%): in 44 patients hemorrhages occurred after electroexcision of the polyps.

Adult↗
PubMed2004

Value of helical computed tomography in the management of upper esophageal foreign bodies.

PURPOSE: To analyze the utility of helical computed tomography (CT) in the diagnosis of suspected upper esophageal foreign bodies. MATERIAL AND METHODS: A prospective study was performed on 36 patients (26 F, 10 M, mean age 70 years) with a history of foreign body impaction. All had negative findings at indirect laryngoscopy. Radiologic assessment included unenhanced helical CT and a barium contrast study. Patients with positive findings were taken to esophagoscopy. All patients had a posterior clinical surveillance. RESULTS: Twenty patients had both normal CT and barium study and satisfactory clinical outcome. In 12 patients a foreign body was noted in the cervical esophagus by CT, barium study, and endoscopy. In one patient a fish bone was detected by CT (and not by barium) confirmed with esophagoscopy. Another patient had a fish bone esophageal perforation which was observed only by CT and confirmed at surgery. Two patients with normal barium and endoscopy presented a false-positive CT result. CONCLUSION: Barium swallow is currently the first radiologic study, but may involve a risk of aspiration and can impede a subsequent esophagoscopy. Esophagoscopy is an invasive technique with a certain risk of serious complications that can be avoided with a satisfactory radiologic assessment. CT is easy, fast, has 100% sensitivity and is therefore the first choice technique for diagnosing suspected upper esophageal foreign bodies not expected to be visible on plain radiographs.

Aged↗