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PubMedDate not supplied

Oesophageal perforation following endoscopic variceal ligation and balloon tamponade.

Endoscopic variceal ligation (EVL) related complication is rarely reported. A case is presented of a 74 year old man with oesophageal variceal bleeding who developed oesophageal perforation following EVL and balloon tamponade. An oesophageal wall defect was induced by EVL and tissue repair was hindered by decompensated liver reserve and shock status; concomitant balloon tamponade precipitated oesophageal perforation. The case is reported to draw attention to oesophageal perforation after concurrent use of balloon tamponade and EVL.

Aged↗
PubMed1981

Management of oesophageal perforation associated with benign stricture and hiatus hernia by oesophagoplasty and fundoplication.

The operation of oesophagoplasty and Nissen fundoplication has proved valuable in the management of intractable peptic stricture of the oesophagus. This report concerns its use in perforation of the oesophagus in an 81-year-old woman with benign peptic stricture in whom perforation occurred during instrumentation. She made an uneventful recovery from operation and remained well and able to swallow without difficulty at three-month follow-up.

Aged↗
PubMed1984

Sclerotherapy for bleeding oesophageal varices--a fatal complication. A case report.

Although injection sclerotherapy for the control of bleeding varices is considered a relatively safe procedure, major complications can occur. A case is presented in which delayed perforation of the oesophagus due to ulceration led to a fatal outcome. The technique used and complications of the procedure are briefly discussed.

Esophageal Diseases↗
PubMed1996

[Non-surgical treatment of perforations of the thoracic esophagus].

OBJECTIVES: Thoracic oesophageal perforations are life-threatening conditions requiring immediate treatment. The type of treatment remains however controversial. The aim of this study was to evaluate the efficacy of the nonoperative management in this disease. METHODS: Six patients were admitted in our surgical unit for thoracic oesophageal perforations during the study period. One perforation was spontaneous (Boerhaave's syndrome). One had complicated an oesophageal ulcer. Two were secondary to caustic lesions. Two were secondary to instrumental dilations. The diagnostic and therapeutic delay was < or = 1 day in 5 cases. In one case the delay was 4 days but the mediastinitis was well tolerated. The treatment was based on antibiotics, nasoesophageal tube suction, and total parenteral nutrition. RESULTS: There was no death in this group of patients. The mediastinitis healed in all cases. In the follow-up period two patients did not have nutritional restriction after healing. Three patients complained of oesophageal stenosis which required oesophageal replacement (n = 2) and dilation (n = 1). One neoplastic stenosis required an endoprosthesis. CONCLUSION: Nonoperative treatment is feasible and safe in selected cases of thoracic oesophageal perforations: perforations diagnosed early and confined to the mediastinum, instrumental perforations, and perforations diagnosed late but well tolerated.

Adult↗
PubMed2002

Management of iatrogenous esophagus perforation.

OBJECTIVES: The management of patients with iatrogenous, instrumentally caused esophageal disruptions is still a controversially discussed challenge for any physician. We reviewed indications, morbidity, and mortality of esophagectomy compared to less aggressive treatment schemes in the light of our single-unit experience. PATIENTS AND METHODS: We reviewed the cases of 38 consecutive patients suffering from iatrogenous esophageal disruption treated within the last 10 years at the University Medical School Graz. RESULTS: Severe sepsis was diagnosed in seventeen patients; fourteen of the seventeen patients were treated by esophagectomy followed by primary or secondary reconstruction at a mortality rate of 28.6 % (four of fourteen patients). All fourteen patients thus treated had major preexisting esophageal pathologies. In three of the total seventeen cases reviewed, conservative treatment modalities were used. The mortality rate in the non-septic group treated by direct suturing (n = 21) was 4.8 % (one of twenty-one patients). Major preexisting esophageal pathology was present in thirteen. The overall mortality was 13.2 % (five of thirty-eight patients). CONCLUSION: The strategy of primary repair for iatrogenous esophageal injury should only be adopted in patients with minor or without intrinsic esophageal disease, and in the absence of severe sepsis suggesting mediastinitis. Severe sepsis following iatrogenous esophageal trauma should prompt the decision for esophagectomy where anatomically and/or oncologically possible.

Esophageal Diseases↗
PubMed1999

Gastroesophageal reflux disease as a cause of death: analysis of fatal cases under conservative treatment.

BACKGROUND: Treatment of gastroesophageal reflux disease (GERD) with modern acid-suppressive agents is supposed to be effective and safe. However, there have been only a few studies on the mortality in GERD today. In the 1960s the mortality was 0.10-0.17/100,000 per year. METHODS: From 1990 to 1995, according to Statistics Finland, 78 official death certificates were issued in which GERD was stated to have been the immediate or a primary cause of death. RESULTS: On completion of analysis data on 52 patients were included in the study. The annual death rate was 0.20/100,000. The causes were hemorrhagic reflux esophagitis in 51.9%, aspiration pneumonia in 34.6%, perforation of esophageal ulcer in 9.6%, and spontaneous esophageal rupture with reflux esophagitis in 3.9%. Thirty-eight patients had been treated with omeprazole or an H2 antagonist, and 44 patients (85%) had severe concomitant disease. CONCLUSION: The mortality in conservatively treated GERD has not decreased. Patients with mental disorder, heart disease, or alcoholism constitute the group in which risk of death from conservatively treated GERD is likely to be greatest.

Aged↗
PubMed2004

[Iatrogenic perforation of the esophagus during transesophageal echocardiography. A rare cause of severe dysphagia].

HISTORY: A 65-year-old patient underwent transesophageal echocardiography which caused a perforation of the upper esophagus. Three months after esophagostomy and gastrostomy the reconstruction was accomplished by a colon interposition graft. The patient postoperatively developed an ischemic necrosis of the graft, followed by a cervical fistula. Food intake and swallowing became impossible. DIAGNOSIS: X-ray examinations revealed the cervical fistula and a stenotic colon graft. TREATMENT AND COURSE: The retrosternal colon graft was replaced by a gastric interposition graft, which was anastomosed with the cervical esophagus. The postoperative follow-up was normal at first. Increasing retention of secretion in the remaining esophagus however caused dilatation and a cervival fistula again, as well as a pleural empyema. After transthoracic resection of the esophagus the patient was finally free of symtoms, and gained weight on unrestricted food intake. CONCLUSION: Transesophageal echocardiography is a common diagnostic procedure with a low complication rate. Even though serious complications may occur in rare cases, the patient must be informed about the risk. The perforation of the esophagus is an emergency situation that requires surgical treatment immediately. Primary reconstruction and preservation of the esophagus is the recommended strategy.

Aged↗
PubMed1978

[The radiological appearances of caustic burns in the upper intestinal tract (author's transl)].

Seventy-nine caustic burns of the upper gastrointestinal tract were divided into early and late effects. The radiological findings were analysed and discussed. The central role of radiology proved to be indisputable, particularly for demonstration of a perforation and for the control of treatment. Endoscopy is of particular value in the diagnosis of caustic burns if the radiological findings are negative, for following treatment and for clarifying atypical late changes.

Burns, Chemical↗
PubMed1989

Intrathoracic oesophageal perforations following bougienage: a protocol for management.

Perforation of the thoracic oesophagus is a serious complication of oesophagoscopy and bougienage for oesophageal strictures. In the last 7 years, 10 such cases have been treated without mortality by following a particular treatment protocol. Irrespective of the duration of perforation, extent of contamination or severity of symptoms, all patients underwent thoracotomy for pleuromediastinal toilet and drainage. Decompressive gastrostomy and feeding jejunostomy was done and a nasogastric tube was left across the stricture to serve as a stent. A thread attached to the nasogastric tube helped in retrograde dilatation after healing of perforation. Infection was controlled with intravenous gentamicin, cloxacillin and metronidazole. In all patients, the perforation healed. Colonic transposition was done in three cases at a later date. The rest required periodic dilatation of the oesophagus either by peroral or retrograde approach.

Adolescent↗
PubMed1975

Complications of Fiberoptic Endoscopy. I. Esophagoscopy and Gastroscopy.

Flexible fiberoptic endoscopes are being used increasingly for direct visualization and biopsy of lesions in the upper gastrointestinal tract. Contrary to earlier expectations, however, the incidence of complications has not diminished despite the technical advantages of modern flexible instruments over semirigid endoscopes; indeed, the mortality of fibergastroscopic perforation has almost quadrupled compared to standard gastroscopy. The authors cite their experience with the spectrum of complications associated with fiberoptic esophagoscopy and gastroscopy. Radiological recognition and evaluation of these iatrogenic incidents is of paramount importance.

Adult↗
PubMed1983

Oesophageal perforation after sclerotherapy for variceal haemorrhage.

The significance of serious complications after endoscopic sclerotherapy is growing alone with the increasing popularity of this method. In a consecutive prospective series of 91 patients with massive haemorrhage from oesophageal varices, treated with fiberendoscopic injection sclerotherapy, four cases of oesophageal necrosis and rupture were encountered.

Adult↗