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At least 1,405 records · Page 78Linked to original sources
PubMed2005

Delayed esophageal necrosis and perforation secondary to thoracic aortic rupture: a case report and review of the literature.

Delayed esophageal necrosis secondary to aortic rupture is extremely rare but potentially fatal. Although diagnostic techniques have improved, survival remains rare. The clinical and imaging features have not been characterized, as no large series have been reported since the advent of computed tomography (CT) and endoscopy. Moreover, as delayed esophageal necrosis secondary to aortic rupture is rarely anticipated, diagnosis is usually delayed. We recently encountered a case of this complication and present this along with a literature review, in order to facilitate early recognition and treatment. In many cases, hemodynamics remain relatively stable despite aortic rupture and the long interval between onset and operation. Dysphagia is therefore an important symptom that may indicate compression of the esophagus and subsequent esophageal necrosis. Preoperative total obstruction of the esophagus on barium swallow, endoscopy, or CT is also an important feature suggesting ischemic change of the esophagus. Endoscopy often reveals an annular ulcer suggestive of an ischemic process leading to necrosis. Death generally occurs from severe mediastinitis occurring after graft repair of the aorta. We recommend performing postoperative endoscopy after aortic surgery when preoperative obstruction of esophagus is found. If endoscopy reveals annular necrosis, surgical treatment involving esophagectomy and omental translocation should be performed expediently before perforation occurs.

Aged, 80 and over↗
PubMed1998

De-epithelialization for esophageal cyst by video-assisted thoracoscopic surgery monitored by esophagoscopy.

In a 26-year-old male a congenital esophageal cyst was de-epithelialized using electro-cauterization via video-assisted thoracoscopic surgery (VATS) together with esophagoscopy. As the cyst adhered firmly to the esophageal muscle layer and mucosa, partial excision of the cyst and burning up of the cystic mucosa by electro-cauterization was performed to prevent esophageal mucosal perforation and postoperative esophageal dysmotility. Intraoperative video esophagoscopic monitoring enabled esophageal mucosal perforation to be avoided. Postoperative barium esophagography revealed good esophageal motility, and the patient showed no symptoms of esophageal dysmotility. We conclude that de-epithelialization for congenital esophageal cysts using VATS together with esophagoscopy is a minimally damaging and reasonable curative procedure without postoperative complications.

Adult↗
PubMed2003

Endoscopy in eosinophilic esophagitis: "feline" esophagus and perforation risk.

BACKGROUND & AIMS: Idiopathic eosinophilic esophagitis is an underdiagnosed disease with typical endoscopic findings, which have not been well described. METHODS: Charts and pathology reports at two tertiary care centers from June 1993 to April 2002 were reviewed to describe the endoscopic findings of this disease and to correlate them with clinical characteristics. Eight patients were identified as having eosinophilic esophagitis based on clinical symptoms and pathology reports. RESULTS: Soft and subtle ring(s) in the esophagus were found in 7 of 8 patients. In 3 of 8 patients, the esophagus appeared rigid. Mucosal rents occurred with simple passage of the endoscope in 5 of 8 patients. One patient developed a perforation after simple passage of the endoscope. Endoscopic findings can be normal or very subtle in these patients, and the findings can easily be missed during endoscopy. Tearing of the esophagus can occur with simple passage of the endoscope or biopsy even in the absence of overt rings. A minimum of 8 weeks of medical therapy (proton pump inhibitor, histamine antagonists, immunosuppressants) should be undertaken before considering dilation because of the high risk involved with the procedure and the good response to medical therapy. CONCLUSIONS: We recommend considering dilation only in patients with eosinophilic esophagitis who do not respond to medical therapy and have rings that appear to be obstructing the lumen.

Adult↗
PubMedDate not supplied

Masking of the symptoms of esophageal and bowel perforation by combination treatment of sepsis with polyvalent immunoglobulins and low-dose hydrocortisone.

Sepsis is usually treated with surgical drainage, antibiotics, oxygenation optimization and volume resuscitation. Recent monoclonal and polyclonal anti-bodies have been used to treat sepsis by neutralizing the endotoxins and cytokines found in septic patients. This method does not significantly reduce mortality except in certain sub-populations of the treatment groups. We introduced a combination approach for sepsis treatment. This adjuvant therapy consists of polyclonal human immunoglobins together with infusion of low-dose hydrocortisone. This paper reports the results of this treatment in two different cases.

Anti-Inflammatory Agents↗
PubMed1978

Esophageal intubation in the management of perforated esophagus with stricture.

Insertion of a Celestin tube was employed in the treatment of 5 elderly patients who sustained perforations of the thoracic or abdominal esophagus during dilation of benign or malignant strictures. Two perforations treated within 24 hours were closed by direct suture in addition to intubation. There was a delay of 24 to 48 hours between the occurrence of the perforation and treatment in the other 3 cases. Only 1 of the latter patients subsequently developed pleural effusion, and this responded to drainage. One patient died 3 weeks after intubation; there was no evidence to suggest continued leakage through the perforation. The Celestin tube appears to be effective in sealing off esophageal perforations while healing occurs and merits consideration in the management of esophageal perforations associated with stricture in elderly patients when more radical treatment is not envisaged.

Aged↗
PubMed1997

Laparoscopic Nissen fundoplication: where do we stand?

Laparoscopic Nissen fundoplication was first performed in 1991. With the increasing number of these procedures being performed it is appropriate to review the published short-term results. A retrospective review of reports on this subject was performed. There were a total of 2453 patients available for review. Twenty-five of 2453 (1.0%) patients had an esophageal or gastric perforation and 28 of 2453 (1.1%) patients required transfusion for bleeding. Forty-nine of 2453 (2%) patients developed a pneumothorax. Two of 2453 (0.1%) patients required a splenectomy. Conversion to the open procedure was necessary in 5.8% (143 of 2453) of patients. The laparoscopic approach is associated with minimal postoperative morbidity. Four of 2453 (0.2%) needed further early surgery for persistent bleeding, 11 of 2453 (0.4%) for a missed perforation, 22 of 2453 (0.9%) for crural disruption, paraesophageal herniation, or gastric volvulus. Four of 2453 (0.2%) patients died of either a missed duodenal perforation, a missed esophageal perforation, ischemic bowel with mesenteric thrombosis, or myocardial infarction. Early postoperative dysphagia occurred in 500 of 2453 (20.3%) patients. Late postoperative dysphagia occurred in 114 of 2068 (5.5%), with the need for dilatation in 72 of 2068 (3.5%). Endoscopy was required for food impaction in 11 of 2068 (0.5%) and re-operation for dysphagia occurred in 18 of 2068 (0.9%). Fifty-seven of 1658 (3.4%) patients developed reflux symptoms and 11 of 1658 (0.7%) required revisional surgery. Satisfaction rates ranged from 87 to 100%. In the short term, laparoscopic fundoplication can be performed with less morbidity and mortality than the open procedure. It is superior to medical therapy. Long-term follow-up is awaited.

Esophagitis, Peptic↗
PubMed1985

Localized absence of colonic musculature: an unusual cause of perforation in a colonic esophageal transplant.

A 4 1/2-year-old boy underwent subtotal esophageal substitution by left colon for caustic soda stricture. The transposed colon had to be removed for perforation 9 days later, and pathological examination showed several tiny perforations in an area 1.8 cm in diameter where the colonic wall was thin and devoid of muscularis. Arguments are presented to show that this absence of muscle coat is congenital. The perforations are thought to be the result of minimal ischemia in a colonic wall weakened by the defect.

Child, Preschool↗
PubMed2001

Incidence and management of esophageal stricture formation, ulcer bleeding, perforation, and massive hematoma formation from sclerotherapy versus band ligation.

OBJECTIVES: The aim of this study was to compare the incidence and endoscopic management of esophageal stricture formation, significant ulcer bleeding, massive esophageal hematoma, and perforation resulting from endoscopic band ligation or sclerotherapy of esophageal varices. METHODS: Consecutive esophagogastroduodenoscopies in which band ligation or sclerotherapy was performed for acute or obliterative therapy were entered into a computerized endoscopy database during a 7-yr period. Patients were excluded if they died within 72 h of treatment session from complications unrelated to the procedure. Sclerotherapy was performed using a 25-gauge needle with 1.5% sodium tetradecyl sulfate and banding was primarily performed with a Wilson-Cook 6 or 10 shooter. Complications were assessed at scheduled endoscopy and outpatient clinic visits, review of quality assurance data tallied on a monthly basis, and patient records. RESULTS: Two hundred twenty-one cases of sclerotherapy were performed in 59 patients compared to 110 cases of band ligation in 52 patients. Five patients were excluded because of death within 72 h of the procedure. The incidence of complications from sclerotherapy:banding on a per patient basis included: esophageal stricture formation 25.6%:1.9%, ulcer bleed 25.4%:5.7%, esophageal perforation 2.2%:0%, and massive esophageal hematoma 1.6%:0%. A significant difference in complications between sclerotherapy and band ligation was noted for both stricture formation (p < 0.0005) and ulcer bleeding (p < 0.0001). The majority of ulcer bleeds required no therapeutic intervention, whereas stricture formation required multiple dilation sessions. CONCLUSIONS: Band ligation has a significantly lower incidence of stricture formation and ulcer bleeding compared to sclerotherapy. The majority of complications can be managed with endoscopic interventions.

Databases, Factual↗
PubMed1986

The diagnosis and management of perforations of esophagus and pharynx sustained during intubation of neoplastic esophageal strictures.

Twenty-six esophageal and eight pharyngeal perforations sustained during palliative intubation of esophagogastric neoplasms have been reviewed. The majority of the tears were recognized either endoscopically or by the immediate development of subcutaneous emphysema. However, 15 perforations were first identified by radiology, and 10 of these 15 patients were initially asymptomatic. In the years 1976-1979 with conservative management, three patients of eight died from the perforation and none had a pneumothorax. From 1980 a more aggressive nonsurgical approach was used, and of 26 patients who sustained a perforation, there were six deaths before leaving hospital but only four deaths were directly related to the perforation and each of these had sustained a pneumothorax. Pharyngeal tears invariably did well with conservative management. Our experience favors conservative management for instrumental esophageal perforation.

Adenocarcinoma↗