Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ESOPHAGEAL PERFORATION”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 973 records · Page 54Linked to original sources
PubMed2000

Variceal rebleeding and recurrence after endoscopic injection sclerotherapy: a prospective evaluation in 204 patients.

HYPOTHESIS: Eradication of esophageal varices by repeated injection sclerotherapy and maintenance of eradication using continued surveillance endoscopy may reduce recurrent variceal bleeding and death from esophageal varices. DESIGN: A prospective study of consecutive adult patients with endoscopically proved esophageal variceal bleeding. SETTING: A tertiary care university hospital in a metropolitan area. PATIENTS: Two hundred four patients (127 men and 77 women; mean age, 50.1 years; age range, 16-82 years) underwent 993 emergency and elective variceal endoscopic injection treatments with 5% ethanolamine oleate during 1992 endoscopy sessions. Most (166 [81.4%]) had cirrhosis, mainly due to alcohol abuse (131 [78. 9%]). The number of patients with each modified Pugh-Child risk grade was as follows: A, 30; B, 91; and C, 83. (The modified Pugh-Child classification comprises ascites, encephalopathy, serum albumin and bilirubin levels, and prothrombin time. Each variable is given a value of 1 to 3 with increasing impairment of liver function. Addition of the values leads to the Pugh-Child risk grades for each patient, with 5 and 6 giving grade A; 7 through 9, grade B; and 10 through 15, grade C, respectively.) RESULTS: Ninety-five patients (46.6%) rebled at a median of 17 days (range, 0-2583 days). Seventy-four patients (36.3%) had a total of 112 further bleeding episodes before eradication of varices. Varices were eradicated in 99 (87.6%) of 113 patients who survived longer than 3 months after a median of 5 injections and remained eradicated in 43 (mean follow-up after eradication, 38 months; range, 4-125 months). Rebleeding was markedly reduced after eradication of varices. Varices recurred in 56 patients, of whom only 10 rebled from recurrent esophageal varices. Cumulative survival by life table analysis was 55%, 41%, and 30% at 1, 3, and 5 years, respectively. One hundred thirty-seven patients (67.2%) died during follow-up. Liver failure was the most common cause of death. Minor complications (mucosal ulceration) occurred in 105 patients. Major complications, including a localized injection site leak (n = 9), esophageal stenosis (n = 25), and esophageal perforation (n = 5), occurred in 39 patients. CONCLUSIONS: Repeated injection sclerotherapy eradicated esophageal varices in most long-term patients. Complications related to injection sclerotherapy were mostly minor. Complete eradication of varices reduced rebleeding and death from esophageal varices.

Esophageal and Gastric Varices↗
PubMed2007

Intermittent dysphagia for solids associated with a multiringed esophagus: clinical features and response to dilatation.

The entity of the multiringed esophagus, generally presenting in adults as intermittent dysphagia for solids, is relatively uncommon and its pathogenesis is unknown. The goal of this study was to describe the demographic, clinical, and endoscopic features of patients presenting with this condition, their response to esophageal dilatation, and the relationship of multiple esophageal rings to eosinophilic esophagitis. Between 1989 and June 2004, 32 patients at this adult hospital fulfilled the following inclusion criteria: (1) intermittent dysphagia for solids, (2) multiple esophageal rings at endoscopy, and (3) esophageal dilatation(s) performed. Response to esophageal dilatation was measured by need for subsequent dilatations. Seventy-five percent of the patients were male. Median age at onset of dysphagia was 21 years and at presentation 36.5 years. All had multiple rings in the proximal or midesophagus on endoscopy and had undergone a total of 73 esophageal dilatations with no esophageal perforations. Median maximal dilator size was 15 mm; however, 16% developed significant esophageal mucosal tears even with 11-mm dilators. Sixty-six percent required repeat dilatation, with the median time interval before recurrence being 8 months. Eosinophilic esophagitis (mucosal eosinophil count > 20/HPF) was present in 50% of this cohort. From this study we conclude that a multiringed esophagus causing intermittent dysphagia occurs predominantly in young males, responds well to dilatation, but repeated dilatations are often necessary. Dilatation can lead to extensive mucosal tears and should be performed with caution. Eosinophilic esophagitis is commonly but not invariably associated with this entity. Frequent relapse of dysphagia highlights the need for effective pharmacotherapy.

Adolescent↗
PubMed2006

Successful sealing of benign esophageal leaks after temporary placement of a self-expanding plastic stent without fluoroscopic guidance.

INTRODUCTION: We report on our experience with the temporary use of a self-expanding plastic stent (SEPS) in the treatment of non-malignant esophageal leaks. MATERIAL AND METHODS: Between November 2001 and May 2005 ten patients with iatrogenic esophageal perforations (n = 4), post-surgical leaks (n = 5) and esophago-mediastinal fistulas after caustic injury (n = 1) were treated by temporary SEPS placement. In eight out of ten patients SEPS placement was done without fluoroscopy due to the emergency setting. Stent removal was performed with a rat-toothed forceps. RESULTS: Leaks were located in the proximal (n = 1), middle (n = 6) and distal (n = 3) parts of the esophagus. The mean leakage size was 2 cm. Stent placement without fluoroscopy was always successful. The median duration of stent therapy was 55.5 days (range 15,438). In 7/10 cases the SEPS was readily removed, showing complete healing of the former leak. Four patients died during the follow-up. However, their deaths were not related to the stent therapy. DISCUSSION: The temporary use of the SEPS represents a safe method for sealing benign esophageal leaks. In the emergency-setting SEPS placement without fluoroscopy is feasible and the stent can be easily removed. In contained perforations without severe mediastinitis of the mid esophagus the SEPS should be discussed as a gentle first-line therapy.

Esophageal Perforation↗
PubMed2006

Long-term observation and functional state of the esophagus after primary repair of spontaneous esophageal rupture.

BACKGROUND: Long-term outcome of patients treated for a spontaneous esophageal rupture (Boerhaave's syndrome) is seldom reported. METHODS: From 1989 to 2004, 62 esophageal perforations were treated in a single institution. Eighteen patients presented with a spontaneous esophageal rupture. Among them, 15 could be treated with a transthoracic primary repair and constituted the material of the present study. A chart review was performed with special attention to survival, residual symptoms, and anatomic and motility disorders. RESULTS: Three patients died postoperatively (20%). At last follow-up, 10 patients were alive and 2 had died from unrelated causes. At a median delay of 13 months (3 to 74), 7 patients accepted to undergo complementary investigations. None of them had any anatomic abnormality as checked by barium swallow. Six patients complained of mild symptoms from gastroesophageal reflux. Six patients (85%) presented with esophageal motility disorders on manometry and 4 (54%) had nocturne chronic reflux disease on pH monitoring. Two patients underwent endoscopic ultrasonography, of which one presented with a focal absence of one layer of the esophageal wall within the area of the suture. With time, no patient experienced recurrence, but one developed a cancer in the cervical esophagus. CONCLUSIONS: These results suggest that esophageal functional disorders are the rule after primary repair of a Boerhaave's syndrome. Whether or not these findings are causal, coincidental, or related to the surgical treatment remains unclear. However, performance of routine postoperative explorations is strongly encouraged for a better understanding of this challenging condition.

Aged↗
PubMed2000

[Laparoscopic cardiomyotomy in the treatment of achalasia].

The laparoscopic cardiomyotomy (Heller) with Dor type anterior fundoplication is accepted for treatment of esophageal achalasia. Between December 1994 and December 1998, 21 patients with esophageal achalasia underwent laparoscopic Heller's operation with Dor's antireflux procedures after preoperative assessment which involved radiological, endoscopic and manometric investigations. Results were evaluated on the basis of our experiences and postoperative investigations. There were no intraoperative complications. Operating time was 40-90' (mean 65'). Conversion to laparotomy was not required. One patient had postoperative stenosis, and another had esophageal perforation which was treated. Postoperative manometry in all patients showed a decreased lower esophageal sphincter pressure. Based on the obtained results it could be concluded that cardiomyotomy with Dor fundoplication through a laparoscopic approach leeds to good functional results and seems effective and safe procedure in the treatment of esophageal achalasia.

Adolescent↗
PubMed1996

Management of esophageal varices in children by endoscopic variceal ligation.

Endoscopic variceal sclerotherapy (EVS) has been considered the mainstay of therapy for bleeding esophageal varices in adults. However, recent data have shown that endoscopic variceal ligation (EVL) is just as efficacious and has fewer complications than EVS. Although there are many reports concerning EVL in adults, only a few studies have been done in children. This report describes experience with EVL in 22 children with esophageal variceal hemorrhage. Eighty-seven EVL procedures were performed during a 9-year period in 22 children. The causes of portal hypertension were biliary atresia (10), portal vein thrombosis (8), chronic active hepatitis (1), cirrhosis secondary to cystic fibrosis (2), and primary sclerosing cholangitis (1). The age range at the onset of variceal bleeding was 8 months to 19 years. Twelve patients had EVS before EVL treatment was begun. Distal esophageal varices (one to four per session) were mechanically ligated using an elastic band ligature device attached to a flexible endoscope. The aim of therapy was obliteration of distal esophageal varices by EVL, every 2 to 4 weeks, until eradication. Subsequent EVL was dictated by the status of the varices. Outcome was assessed with respect to survival, rebleeding, status of varices, and complications. The patients underwent a mean of four sessions of EVL (range, one to eight). Four patients subsequently underwent liver transplantation. Of the 18 patients remaining (average follow-up period, 5.3 years), 12 had their varices eradicated (average of four EVL sessions), four are still in treatment, one has not been evaluated in the past 4 years, and one died of liver failure. Complications included bleeding between sessions (6 patients), cervical esophageal perforation (1 patient), and transient fever (2 patients). No child has experienced symptoms of esophageal stenosis or gastroesophageal reflux. Two patients died of liver disease, unrelated to bleeding from portal hypertension. EVL is effective in controlling variceal hemorrhage in children with portal hypertension, regardless of etiology. The complication rate is low, and EVL is an acceptable and perhaps preferable alternative to EVS in children with esophageal varices.

Adolescent↗
PubMed1987

Cardiac tamponade and constrictive pericarditis complicating endoscopic sclerotherapy.

We report a case of suspected esophageal perforation with injection of a sclerosing agent into the pericardium during endoscopic sclerotherapy of esophageal varices. Immediately after the procedure, the patient developed fever and a pericardial friction rub. Eight months later, he presented with cardiac tamponade and constrictive pericarditis. This complication should be considered whenever a patient presents with inadequate cardiac output, venous congestion, and a pulsus paradoxus following sclerotherapy.

Adult↗
PubMed1997

[Esophagobronchial fistula and empyema resulting from esophageal carcinoma].

A 59-year-old woman was admitted to the hospital with a one-month history of hemoptysis, generalized fatigue, and a high fever. A chest X-ray film obtained on admission showed a massive right-sided pleural effusion. Examination of an aspirate showed a high level of amylase, and bacteria that were the same as oral bacteria. Closed drainage yielded ichorous pus and food residues, which led us to the diagnosis of empyema caused by esophageal perforation. Esophagography and fiberoptic esophagoscopy revealed that an esophagobronchial fistula related to an advanced esophageal carcinoma had caused the empyema. Surgical resection was done, and the patient was alive at the time of this writing, 7 months after she was first treated. Esophageal carcinoma is sometimes accompanied by esophagobronchial fistula. Patients with this condition usually have severe respiratory symptoms; those presenting with empyema are rare. Esophageal carcinoma must be carefully ruled out as the cause of empyema.

Bronchial Fistula↗
PubMed1991

[Spontaneous rupture of the esophagus].

Spontaneous rupture of the esophagus is a rare emergency that requires immediate diagnosis and superior surgical treatment. Delay in diagnosis is common and is caused mostly by lack of consciousness of the disease and consequent tendency to diagnose a cases as perforated peptic ulcer, pancreatitis, acute coronary disease etc. Mortality and morbidity increase proportionally to the time between esophageal perforation and adequate treatment. In this paper the Authors present a case of Boerhaave's syndrome in a patient who underwent two surgical repairs followed by leakages of the esophageal sutures. The definitive successful treatment has been obtained with a third operation performed after complete sterilization of the mediastinum.

Adult↗
PubMed2002

Minimally invasive approach to Boerhaave's syndrome: a pilot study of three cases.

BACKGROUND: Boerhaave's syndrome requires urgent thoracotomy, laparotomy, or both for esophageal repair and pleuromediastinal debridement. Minimally invasive techniques may be suitable alternatives. MATERIALS AND METHODS: Over a period of 12 months, three patients with spontaneous esophageal perforations after forceful vomiting were treated by a combination of minimally invasive techniques including laparoscopy, thoracoscopy, mediastinoscopy, and endoscopic stenting. RESULTS: Esophageal repair was performed transhiatally via laparoscopy using primary suture, primary suture reinforced by a fundic patch, and fundic patch alone in one patient each. One patient had a second perforation of the proximal esophagus, which was sutured through a cervical incision. This patient successfully underwent secondary endoscopic stenting for a persistent esophageal fistula. Mediastinal debridement was performed transhiatally and also by means of a mediastinoscope introduced via the cervical incision in one patient. One patient required secondary thoracoscopic debridement of a pleural empyema but died of sepsis after 1 month. The two other patients recovered and were discharged from the hospital after 2 and 8 weeks, respectively. CONCLUSIONS: Boerhaave's syndrome is amenable to minimally invasive techniques. Avoidance of a formal thoracotomy with its resulting morbidity could be of considerable benefit to these critically ill patients.

Aged↗
PubMed1981

Boerhaave syndrome. Successful conservative management in three patients with late presentation.

Three patients with Boerhaave syndrome were successfully managed with nonoperative treatment. The diagnosis was delayed 5 days in one patient and 10 days in the other two. None of the patients appeared septic. Their conditions had been misdiagnosed as myocardial infarction, pneumonia and pulmonary embolism. Treatment consisted of intravenous hyperalimentation and administration of antacids and antibiotics. Cimetidine was also used in one patient. Two patients were discharged 14 days after diagnosis and the third on the 20th hospital day. Follow-up barium swallows showed complete healing in 2 months in all three patients. Conservative management of spontaneous esophageal perforation is feasible when (1) the perforation is already 5 days old, (2) there are no signs of severe sepsis, (3) esophageal barium study shows a wide-mouthed cavity draining freely back into the esophagus, and (4) the pleural space is not contaminated. When the diagnosis is made promptly, surgical therapy remains the treatment of choice, and patients managed conservatively who show signs of sepsis should be operated on without hesitation. Follow-up esophageal evaluation should be performed to confirm complete healing and to evaluate underlying disease.

Antacids↗
PubMed1986

Alkaline ingestions.

Alkaline ingestion is a potentially life-threatening problem that may confront the emergency physician. It is similar to many other toxins in that children and those who attempt suicide are its most common victims; however, implications in terms of initial stabilization and definitive care are quite distinct. Mucosal exposure to lye results in a quick, deep liquefactive necrosis. Consequently, blind nasotracheal intubation may result in the perforation of damaged tissues in the pharynx and trachea. For similar reasons, the blind passage of a nasogastric tube is contraindicated. The use of diluents in this setting is controversial. If a diluent is used, water and milk are considered the liquids of choice. They may be used to irrigate oropharyngeal burns, but are contraindicated in the face of respiratory compromise, shock, liquid lye ingestion, and perforation of the esophagus or stomach. Cathartics and charcoal are not used after alkaline ingestion. Cathartics, however, are used in miniature alkaline battery ingestions to diminish bowel transit time. Esophagoscopy should be done within 12 to 24 hours after ingestion to directly observe the extent of damage. This procedure should be stopped at the first sign of injury to protect against iatrogenic esophageal perforation. Steroids should be started for circumferential esophageal burns and in those patients with significant injury who are unable to undergo esophagoscopy. IV antibiotics are administered for gastrointestinal perforation and may be used concomitantly with steroids. Miniature alkaline batteries lodged in the esophagus must be removed immediately. The available modalities include fluoroscopy-directed Foley catheter removal, endoscopy, and surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Benign esophageal strictures in toddlers and pre-school children. Results of endoscopic dilation].

BACKGROUND: The most frequent causes of dysphagia in children are benign strictures and therefore require special consideration. OBJECTIVE: To evaluate safety and efficacy of endoscopic dilation in children with benign esophageal strictures. MATERIAL-METHODS-RESULTS: Twenty four consecutive children of 1.5 to 5.5 years (mean 3.5), with benign esophageal strictures were evaluated in a prospective manner over a 3-year period. The most frequent causes of esophageal stricture were caustic ingestion (Group A) and in Group B were included other benign strictures. Dilation was done on a weekly base using Savary-Gilliard bougies and was considered adequate, if the esophageal lumen could be dilated to 11 mm with complete relief of dysphagia. Of the 24 patients, 16 had corrosive strictures, 6 complications of gastroesophageal reflux and 2 post surgical strictures. Group A required a significantly higher number of session (14.3 +/- 10.84 vs 7.0 +/- 2.94 p: > 0.05), less free-time dysphagia (1.1 +/- 0.39 vs 2.6 +/- 0.95 months p: < 0.01) and a higher number of recurrences (3.12 +/- 1.12 vs 1.25 +/- 0.95 p: < 0.01). Two esophageal perforations occurred during a total of 292 dilation sessions (0.68%). There was one fatality. CONCLUSIONS: Benign esophageal strictures in children can be treated effectively and with acceptable safety by means of endoscopic dilation.

Child, Preschool↗
PubMed1992

[Photodynamic therapy by coloring laser. Can it represent a therapeutic alternative for small epidermoid cancers of the esophagus?].

Our aim was to assess the efficacy of photodynamic therapy in inoperable patients with small esophageal carcinoma. Eleven patients were treated for squamous cell carcinomas ranging in size from 1 to 3 cm2. Hematoporphyrin (between 3 and 5 mg/kg) was injected intravenously and then the tumor irradiated at endoscopy 72 hours later with a dye laser (630 nm) at an energy of 250 joules/cm2. Complete destruction of the lesion was obtained in 6 cases with negative biopsies at 1 month. In all 6 patients, no recurrence was seen after a median follow-up of 4 months (range: 2-38). Partial destruction of the tumor was obtained in 4 cases while treatment was a complete failure in the last patient. Two instances of mild cutaneous photosensitization occurred. Two patients treated for recurrence after radiotherapy, died of esophageal perforation directly related to the procedure. Photodynamic therapy appears to be a possible effective treatment for esophageal squamous cell carcinoma in inoperable patients when other curative treatment modalities are not possible.

Aged↗
PubMed1991

Thoracic manifestations after esophageal variceal sclerotherapy.

Endoscopic esophageal variceal sclerotherapy (EVS) is often used in the treatment of upper gastrointestinal hemorrhage due to esophageal varices. We retrospectively reviewed the Mayo Clinic experience with EVS between 1980 and 1989 to determine the incidence of thoracic manifestations and chest roentgenographic abnormalities associated with this procedure. The study population consisted of 223 patients who underwent 390 EVS procedures. In all patients, chest roentgenography was done before and after EVS. Ethanolamine oleate or tetradecyl sulfate was used as the sclerosant. Fever, chest pain, and odynophagia were frequent findings after EVS and tended to be short-lived. Local complications at the site of injection, such as esophageal perforation (in 1% of EVS procedures) and abscess (in 0.3%), were infrequent but associated with substantial mortality. Esophageal stricture was noted as a late complication in less than 10% of patients, and clinically recognized aspiration pneumonitis was rare. Respiratory insufficiency developed after 14 EVS procedures. Chest roentgenographic abnormalities, which were commonly detected (after 85% of EVS procedures) but were rarely of clinical significance, included retrocardiac or mediastinal widening or densities (in 35%), pleural effusions (in 27%), atelectasis (in 12%), and pulmonary infiltrates (in 9%). Most thoracic manifestations after EVS are likely due to a local inflammatory response to the sclerosant.

Adolescent↗
PubMed2004

Esophageal replacement using a reversed gastric tube for lye stricture in a child: report of a case.

A 5-year-old girl ingested lye, a detergent used in electric dishwashers. She was transferred to our hospital after balloon dilatation, performed for stenosis resulting from corrosive esophagitis, was complicated by esophageal perforation causing mediastinitis. Although the mediastinitis resolved with conservative treatment, the stenosis did not improve. Therefore, we performed esophageal replacement using a reversed gastric tube, which successfully relieved the obstruction, although she still had slight gastroesophageal reflux 6 months postoperatively.

Burns, Chemical↗
PubMed2001

Boerhaave's syndrome: a pediatric case.

BACKGROUND: The term Boerhaave's syndrome refers to esophageal rupture after a sudden increase in intraluminal pressure. This syndrome is most common among alcoholic adult men. This case report is that of a pediatric patient with a similar pathologic process. STUDY: A 6-month-old Hispanic boy with acute lymphoblastic leukemia on chemotherapy arrested 3 weeks into his induction therapy. Diagnostic and therapeutic procedures revealed a hydropneumothorax, which was managed with chest tube drainage. The underlying etiology was revealed 10 days later when feeds were introduced and found exiting the chest tube. A contrast study confirmed esophageal perforation, which was surgically repaired. CONCLUSION: A nontraumatic hydropneumothorax should raise the possibility of Boerhaave's syndrome (spontaneous esophageal rupture), even in pediatric patients. Such a finding warrants a contrast study to facilitate early diagnosis.

Antineoplastic Combined Chemotherapy Protocols↗