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PubMed2002

Spontaneous esophageal perforation presenting as meningitis.

This report describes a unique case of spontaneous esophageal perforation (Boerhaave's syndrome) presenting as meningitis. After a delay in diagnosis (16 days), the patient was successfully treated with debridement, primary closure, and drainage. Although rare, central nervous system infections have been reported in association with esophageal perforation caused by instrumentation, trauma, and malignancy. We report this case of spontaneous esophageal perforation giving rise to meningitis.

Adult↗
PubMed2004

Pleural flap for delayed presentation of intrathoracic esophageal perforation.

The authors report 2 cases of large intrathoracic esophageal perforation, as a complication of foreign body in 2 boys, 4 and 9-years-old. The delay in diagnosis was more than 36 hours in both cases that were treated successfully by a large pleural flap. Postoperatively, solid oral feeding was initiated after 2 weeks. Although gastrostomy was not performed on both patients, in cases of large esophageal perforation, it is recommended to establish early feeding and prevent aggressive vomiting.

Child↗
PubMedDate not supplied

Management of esophageal perforation after pneumatic dilation for achalasia.

Current management of esophageal perforation after pneumatic dilation for achalasia is thoracotomy and repair with myotomy. This study aims to assess the outcome of patients managed by laparotomy, and the role of laparoscopic repair. The study was carried out by means of retrospective case review and prospective follow-up with a symptom questionnaire. Results were compared with results in patients undergoing elective Heller myotomy. Over a 20-year period, 445 dilations for achalasia were performed in 371 patients. There were 10 esophageal perforations. Nine patients were referred for surgery and were successfully managed with a transabdominal repair. Laparoscopic repair was attempted in four patients but was successful in only one because of the perforation site. After a mean follow-up of 5.4 years, grade 1 or 2 Visick scores were recorded in all patients. Residual symptoms of dysphagia occurred in 67% in the emergency group and 88% in the elective group. There was an increased incidence of heart-burn compared to elective myotomy. Early operation after perforation provides good results for treatment of achalasia. Mild dysphagia persists and there is an increasing sensation of heartburn. The site of perforation is typically posterolateral, which makes laparoscopic repair difficult.

Catheterization↗
PubMed1984

Esophageal perforation in a neonate associated with gastroesophageal reflux.

This is the first report of a neonate with esophageal perforation in whom an association of gastroesophageal reflux (GER) was detected by esophagraphy and esophageal pH monitoring. The patient was successfully treated for both esophageal perforation of GER by thoracic drainage and fundoplication. In this patient, GER seemed a likely cause of esophageal perforation.

Esophageal Fistula↗
PubMed1989

Cervical esophageal perforation diagnosed by endoscopy in a premature infant: review of recent literature.

A case of cervical esophageal perforation in a premature infant by an orogastric polyvinyl chloride (PVC) tube is reported. Perforation appeared as an esophageal atresia, suspected because of the inability to aspirate gastric secretions. Initially, atresia was confirmed by an esophagogram, but endoscopy revealed a "double esophagus" with a normally located and developed esophagus and a blind mediastinal fistula starting at the opposite side of the glottis. The "double esophagus" was confirmed by an esophagogram, followed by a contrast study in the pharynx. Esophageal perforation in the neonate is an iatrogenic disease that may mimic esophageal atresia. We recommend endoscopy instead of contrast studies for suspected esophageal atresia.

Diagnosis, Differential↗
PubMed1999

[Diagnosis and treatment of cervical esophageal perforation in adults].

OBJECTIVE: To evaluate the management of cervical esophageal perforation in adult patients. MATERIAL AND METHODS: A retrospective clinical review was made of all cervical esophageal perforations diagnosed in adult patients in the ear, nose and throat department of Marqués de Valdecilla Hospital (Santander, Spain) between January 1989 and December 1996. Age, sex, symptoms, cause of perforation, time to diagnosis, diagnostic studies, treatment, and evolution were obtained from the clinical records. RESULTS: Eleven patients with perforation of the cervical esophagus, age range 38 to 84 years, were seen in the study period. In 8 cases, perforation was caused by a foreign body and 3 cases were iatrogenic (after rigid esophagoscopy). The most frequent symptoms of presentation were cervical pain and odinophagia. Nine patients were treated with broad-spectrum intravenous antibiotic therapy and no oral feeding. Two patients were treated surgically. There were no complications or need for further surgery in any case. CONCLUSIONS: Small perforations of the cervical esophagus in adult patients produced by foreign body impaction or rigid esophagoscopy can be managed by observation, restricted oral intake, and intravenous antibiotics. Neck exploration should be reserved for patients with signs and symptoms of cervical or mediastinal infection.

Adult↗
PubMed2005

Esophageal perforation in adults: aggressive, conservative treatment lowers morbidity and mortality.

OBJECTIVE: To evaluate the outcome of aggressive conservative therapy in patients with esophageal perforation. SUMMARY BACKGROUND DATA: The treatment of esophageal perforation remains controversial with a bias toward early primary repair, resection, and/or proximal diversion. This review evaluates an alternate approach with a bias toward aggressive drainage of fluid collections and frequent CT and gastographin UGI examinations to evaluate progress. METHODS: From 1992 to 2004, 47 patients with esophageal perforation (10 proximal, 37 thoracic) were treated (18 patients early [<24 hours], 29 late). There were 31 male and 16 females (ages 18-90 years). The etiology was iatrogenic (25), spontaneous (14), trauma (3), dissecting thoracic aneurysm (3), and 1 each following a Stretta procedure and Blakemore tube placement. RESULTS: Six of 10 cervical perforations underwent surgery (3 primary repair, 3 abscess drainage). Nine of 10 perforations healed at discharge. In 37 thoracic perforations, 2 underwent primary repair (1 iatrogenic, 1 spontaneous) and 4 underwent limited thoracotomy. Thirty-4 patients (4 cervical, 28 thoracic) underwent nonoperative treatment. Thirteen of the 14 patients with spontaneous perforation (thoracic) underwent initial nonoperative care. Overall mortality was 4.2% (2 of 47 patients). These deaths represent 2 of 37 thoracic perforations (5.4%). There were no deaths in the 34 patients treated nonoperatively. Esophageal healing occurred in 43 of 45 surviving patients (96%). Subsequent operations included colon interposition in 2, esophagectomy for malignancy in 3, and esophagectomy for benign stricture in 2. CONCLUSIONS: Aggressive treatment of sepsis and control of esophageal leaks leak lowers mortality and morbidity, allow esophageal healing, and avoid major surgery in most patients.

Adolescent↗
PubMed1997

Laparoscopic closure of esophageal perforation following pneumatic dilatation for achalasia. Report of two cases.

Esophageal perforation following pneumatic dilation of the esophagus is normally recognized shortly after the event. Two patients with esophageal perforation were repaired utilizing a transabdominal laparoscopic technique with suture closure of the perforation, contralateral Heller myotomy, and Toupet posterior partial fundoplication. Patients recovered excellently, were started on liquids within 3 days of surgery, and were discharged shortly thereafter. Details of the procedure are presented. This minimally invasive approach is well tolerated and appropriate in selected patients.

Adult↗
PubMed2004

Esophageal perforation associated with cervical spine surgery: report of two cases and review of the literature.

BACKGROUND/AIMS: Esophageal perforation after anterior cervical spine surgery is a rare complication with various clinical presentations and treatments. METHODS: Two cases of esophageal perforation after anterior cervical spine surgery are described, one occurring in the immediate postoperative period and one several years after plate stabilization of the cervical spine. RESULTS: Primary suturing of the acute perforation and diversion of the salivary flow by means of T-tube placement after delayed presentation allowed successful healing of the esophageal defects. CONCLUSION: When encountering acute dysphagia after cervical spine surgery, one should think of an esophageal perforation and install immediate further diagnostics and therapy. Treatment depends on the time of detection and size of the perforation. In early stages, with vital tissues, primary suturing is the treatment of choice. If presentation is late, it seems advisable to limit the procedure to simple drainage after removal of foreign bodies.

Aged↗
PubMed2002

Iatrogenic esophageal perforation--diagnosis and therapy.

The diagnosis and therapy of iatrogenic esophageal perforation in a group of patients treated for this condition. During the period of 1994-2002 twelve patients suffered iatrogenic esophageal perforation with a mortality rate of 33.3%. The therapeutical approach consisted of either primary repair of the perforation, drainage of the mediastinum and pleural cavity or inserting a stent. (Ref. 6.).

Esophageal Perforation↗
PubMedDate not supplied

Successful conservative treatment for esophageal perforation by a fish bone associated with mediastinitis.

A 74 year-old man presenting with esophageal perforation associated with mediastinitis due to the swallowing of a fish bone is reported herein. Conservative treatment, including starvation therapy and the injection of antibiotic drugs, proved to be successful for this patient. Although the optimal treatment for esophageal perforation remains controversial, it is important to choose the appropriate strategies when treating cases of esophageal perforation with mediastinitis.

Aged↗
PubMed1989

Esophageal perforation at a Barrett's ulcer.

An alcoholic man with known reflux esophagitis and Barrett's esophagus developed fever, epigastric pain, subcutaneous crepitus, and leukocytosis from an esophageal perforation at a Barrett's ulcer. Possible risk factors for perforation in this patient included alcoholism, severe gastroesophageal reflux, corticosteroid therapy, noncompliance with antacid and H2 blocker therapy, and the presence of acid-secreting parietal cells in the Barrett's epithelium. Five cases of this complication have previously been reported in a review of the literature, which included 536 cases of Barrett's esophagus or esophageal perforation. This entity may present with a clinical triad of a patient (a) in acute distress with fever and epigastric or noncardiac chest pain and without signs of peritonitis, (b) with symptoms of or known gastroesophageal reflux, and (c) with chest examination revealing subcutaneous crepitus, or chest roentgenogram revealing subcutaneous emphysema, pneumomediastinum, or hydropneumothorax.

Adult↗
PubMedDate not supplied

[Esophageal perforation caused by balloon dilatations in a patient with achalasia].

OBJECTIVE: To present a case of esophagic perforation due to a pneumatic dilatations of the cardias in a patient with achalasia. BACKGROUND: Achalasia of the esophagus is a primary motor alteration with an unknown cause. The principal characteristics are the lower or absent peristaltic waves in the esophagic body and the impared lower esophagic sphincter relaxation during deglution. The management is palliative with pneumatic dilatations, pharmacologic therapy or with surgery. When a esophagic perforation occurs, it must be diagnosed and treated as soon as possible because a delay in diagnosis and management affect directly the patient prognosis. METHOD: To present a case of esophagic perforation due to pneumatic dilatations of the cardias in a patient with achalasia. CONCLUSIONS: An useful palliative management for achalasia is the pneumatic forceful dilatation, however it carries some risk of perforation; in every patient who was treated with dilatations is mandatory to think in perforation when the clinical condition is different after the procedure. The success of surgical management of the perforated esophagus and the control of sepsis and mediastinitis depends directly of the clinical condition of the patient and the time within perforation and surgical therapy.

Aged↗
PubMed1981

Esophageal perforation in the newborn.

Two cases of esophageal perforation in the newborn are reported. The first case underwent surgery after suspected diagnosis of a traumatic perforation of a superior atresic esophageal stump. The second case was treated with supportive therapy. Both cases were cured and discharged in good health. The possible mechanisms of spontaneous and iatrogenic perforation are discussed.

Esophageal Atresia↗
PubMed1979

Esophageal perforation in an infant: repair with a pleural flap.

Most esophageal perforations regardless of cause, should be treated surgically. Since anatomic features of the esophagus make even small rents difficult to close, a variety of technics have been developed. Flaps of pleura have been used in adults, but to our knowledge this technic has not been previously described in infants. We used a local pleural flap for successful closure of a large esophageal perforation in a 2-week-old infant. Rapid healing occurred without stricture.

Esophageal Perforation↗
PubMed2005

[Treatment of thoracic esophageal perforations].

OBJECTIVE: To evaluate the results of the treatment of patients with thoracic esophageal perforation in order to determine the most appropriate management of this entity. PATIENTS AND METHOD: We performed a retrospective study of 21 patients (mean age 59 years; 24-82) who presented with thoracic esophageal perforation to our hospital between 1991 and 2004. RESULTS: In 13 patients (62%) treatment was performed within 24 hours. In the remaining 8 patients the mean delay was 7.2 (2-12) days. In 4 patients (26%) the perforation was confined to the mediastinum and conservative treatment was provided. Of these patients, 1 developed empyema and underwent esophageal resection. Extramediastinal involvement was confirmed in 17 patients (73%) and was treated by a variety of surgical procedures: esophagectomy (n=2), drainage alone (n=2), primary closure (n=2) and reinforced primary repair (n=11). Two patients with simple closure and 1 with reinforced primary closure developed leakage of the suture line resulting in death. The 3 patients who underwent esophagectomy survived. In patients with perforation confined to the mediastinum mortality was 0%, whereas in those with extramediastinal involvement mortality was 23%. CONCLUSIONS: Thoracic esophageal perforation leads to high mortality rates and requires early diagnosis and immediate treatment. Conservative management is appropriate in only a few selected patients. When surgical treatment is indicated, we advocate reinforced primary repair regardless of the interval between injury and operation, except when the esophagus is in such poor condition that esophagectomy is the only option.

Adult↗