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PubMed1981

[Study of 58 intrathoracic complications in 166 accidental or iatrogenic esophageal injuries].

In 58 patients among 166 cases of esophageal trauma who developed an intrathoracic complication, the cases are studied of 26 esophageal instrumental perforations, 10 vomiting or effort ruptures, 14 ingestions of foreign bodies (observed in a surgical unit), 5 corrosions by acids or alkalis and 3 esophageal injuries after closed chest trauma. Some complications occurred or were recognized after a delay of 1 to 16 days. In 22 cases treated after the second day, 9 patients survived and in 18 cases treated after 4 days, 6 patients nevertheless survived. The outcome is difficult to assess initially but hope must be entertained even in the most severe cases. The discussion focuses on symptoms and signs, modes of clinical presentation and the different types of fistulas (4 intramural, 31 esophago-mediastinal, 15 esophago-pleural, 5 esophago-tracheal, 1 esophago-aortic, 1 esophago-pericardial). Treatment varies with the delay in diagnosis and is often complex. In cases requiring reoperation the mortality is very high.

Accidents↗
PubMed1995

Plastic-covered metallic endoprostheses in the management of oesophageal perforation in patients with oesophageal carcinoma.

OBJECTIVE: To evaluate the role of plastic-covered self-expanding metallic endoprostheses in patients with oesophageal perforation occurring during endoscopically guided dilatation prior to laser treatment for malignant obstruction. SUBJECTS AND METHODS: Six patients with oesophageal perforation following laser treatment for malignant obstruction were treated. Four patients received the polyurethane-covered Wallstent endoprosthesis (Schneider SA, Bulach, Switzerland) and two patients the barbed polyethylene-covered Gianturco stent (William Cook, Europe). RESULTS: All patients had successful stent placement under intravenous sedation and fluoroscopic guidance with immediate relief of dysphagia and sealing of the perforation. Following the procedure all patients could eat either a normal diet or soft food and five patients were discharged within 3-4 days. None of the serious sequelae usually associated with oesophageal perforation were observed. Two patients required second overlapping stents to be inserted within 1 week because of minor migration of the initial endoprostheses. In one patient two stents were necessary because the carcinoma extended over 17 cm. Five patients died after stent insertion (mean survival time = 49 days, range 16-80; median survival time = 37 days, range 16-80) due to a general deterioration in their condition, although all could swallow normally until death. The remaining patient was well and tolerating a light diet at 1 month. CONCLUSION: This technique is quick, safe and cost-effective and is now our preferred method of managing malignant oesophageal obstruction associated with perforation.

Aged↗
PubMed1979

[Roentgen examination after oesophageal surgery (author's transl)].

Sutureinsufficiency has to be sought postoperatively. Later, tumors, passage disturbances and reflux must be looked for. Antirefluxsurgery with fundoplication may lead to a roentgenmorphology with tumoraspect. After transoesophageal sclerosis of varices passage disturbances and perforations may be seen. After perforations by endoscopic procedures the oesophageal roentgen examination with water-soluble substances completes the clinical surveillance.

Esophageal Neoplasms↗
PubMed2004

Ischemic esophageal necrosis secondary to traumatic aortic transection.

Esophageal necrosis with perforation secondary to traumatic aortic transection is extremely rare but usually fatal. A 47-year-old man complained of sudden swallowing difficulty 6 days after blunt trauma. Computed tomography showed a ruptured aorta and the midesophagus shifted to the right side with luminal obliteration because of the ruptured aorta. After primary repair of the partially transected aorta, unexpected mediastinitis because of esophageal perforation was noted. Upper endoscopy showed midesophageal ulceration, necrosis, and perforation. Biopsy samples were consistent with ischemia. The possibility of direct esophageal trauma or intraoperative esophageal injury was ruled out. Esophageal exclusion with thoracoscopic decortication and multiple antibiotics were ineffective, and the patient eventually died. Ischemic esophageal necrosis caused by mechanical compression can occur in a traumatic aortic transection. Dysphagia, when present with radiologic signs, indicates a displaced and compressed esophagus. In spite of aggressive surgical and medical treatment for a perforated esophagus, the prognosis remains poor.

Aorta↗