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At least 1,621 records · Page 90Linked to original sources
PubMed1987

Caustic alkali ingestions by farm children.

Liquid lye drain cleaners responsible for a childhood epidemic of household ingestions in the early 1970s are now marketed in drastically reduced alkali concentrations and packaged in child-resistant containers. However, farm and industrial caustic agents continue to be sold without poison prevention safeguards, as exemplified by dairy pipeline cleaners (liquid NaOH/KOH concentrations 8% to 25%) used routinely on dairy farms. In this study, the ingestion epidemiology of farm/industrial v household caustic alkali products was compared in a population that included farm children. Forty-three children were admitted from 1973 to 1983 to four rural hospitals for nonintentional caustic alkali ingestion. Farm products constituted 23% of all products and 43% of all drain/pipe cleaners ingested. Dairy pipeline cleaners were the single most common causative substance, injuring ten toddlers (mean age 1.6 years), perforating the esophagus in two. Liquid dairy pipeline cleaners were usually ingested in tiny amounts from nonchild-resistant containers or drinking glasses at evening milking time. In contrast, household drain cleaners were associated with fewer ingestions, with all serious complications related to highly concentrated products not available on the consumer market after 1975. Poison prevention strategies successfully applied in the 1970s to household drain cleaners should be redirected and modified for farm-related caustic alkali agents. Preventive measures are suggested by the highly specific pattern of injury and the small, defined population at risk.

Burns, Chemical↗
PubMed1986

Treatment of benign strictures and injuries of the oesophagus with a permanent oesophageal tube introduced through a cervical oesophagostomy. II. Clinical observations.

Eighty-four patients with severe benign oesophageal strictures and/or oesophageal perforation have been managed with a permanent oesophageal tube (POT) introduced through a cervical oesophagostomy. Sixty-eight patients had severe strictures of varying etiology. In these patients, the conservative treatment by bouginage could not be continued due to a stricture unyielding for dilatation or early recurrence of the stricture after a number of dilatations. Eleven of these patients had iatrogen oesophageal perforation at the time the treatment with POT was started. In 16 patients indication for treatment with POT was a severe injury of the oesophagus and in 15 of them it was transmural. The results of the treatment are considered to be satisfactory. The mortality rate, the final results and the factors determining poor results of the treatment are discussed. The treatment with POT introduced through a cervical oesophagostomy is considered to be a valuable method which can be used in cases with stricture and injuries of the oesophagus in which conventional conservative treatment is futile or impossible and resection of the oesophagus undesirable.

Adolescent↗
PubMed1978

[Oesophageal perforations from instrumentation during high fibroscopy. Radiological signs (author's transl)].

The authors report on a survey of perforation following fibroscopy in the Hôpital Saint-Antoine. A total of 10,600 diagnostic examinations were reviewed and 5 perforations were recorded, to which must be added 2 perforations following oesophageal dilatation. A chesy X-ray, taken within 24 hours of the incident, showed, in most cases, the presence of air in the mediastinum with early signs of subcutaneous emphysema in the cervical or cervicothoracic regions. A hydro-pneumothorax in the right side of the chest was also observed in the cases studied, without air in the mediastinum. Oesophageal transit was studied by means of a water-soluble compound, and showed oesophageal effraction in only 4 cases, and in 3 of these cases it was possible to see the location of the orifice with precision.

Adult↗
PubMed1996

[Endoscopic treatment of anastomosis insufficiency and perforation in the esophagus with fibrin glue].

The incidence of anastomotic dehiscence following oesophageal or gastric resection reported in European studies varies between 3.5 and 25%. The outcome of these patients is usually not explained nor is there a relevant number of studies concerning the treatment of this situation. Oesophageal perforation is rare but is commonly combined with high morbidity and mortality. Operative treatment mostly means major surgical procedures. In our institution endoscopic treatment of these defects has been established since 1985. Following the endoscopic diagnosis, the extent of the defect becomes radiologically documented by filling the cavity with contrast media. This also shows any contact to intraoperatively placed drainages. The lesions and abscess cavities are then endoscopically flushed with saline solution on a daily basis analogously to an internal drainage until surfaces are cleansed. Developing granulation tissue and cleansed surfaces are then covered with fibrin tissue adhesive to support shrinking of the defect. During the last 9 years, we treated 46 cases of anastomotic dehiscence and 9 oesophageal perforations applying this regimen. About 50% of the patients showed signs of sepsis at the beginning of their course. The defects were between 1 and 400 ml in size. In a median number of 4 (1-19) endoscopies a median of 8 (1-81) ml of fibrin tissue adhesive was applied. The average costs for fibrin tissue adhesive were about US $720. Close to 80% of the lesions could be healed, only 14% of the patients developed oesophageal stenosis with a consecutive need of dilatation. We therefore conclude that this method is helpful in treating patients with oesophageal lesions, especially if they are in reduced general condition and are at high risk for operative interventions.

Esophageal Neoplasms↗
PubMed2003

[Acute dysphagia: often there is a readily treatable cause].

Three patients, one woman aged 45 years and two men aged 40 and 62 years, presented with acute dysphagia due to oesophageal obstruction by a piece of food. In the woman symptoms of oesophageal perforation developed after the piece of food was removed by rigid endoscopy; she recovered after treatment with a stent, antibiotics and acid inhibitors. The younger man had a stricture of the oesophagus that was dilated. The older man had a Barrett's oesophagus and also oesophagcal adenocarcinoma; he was free of symptoms three years after resection of the oesophagus and the creation of a tubular stomach. In adults, 60% of acute oesophageal obstructions are caused by food impaction, which is associated with a high incidence of secondary pathologic findings in the oesophagus (75-97%). Evaluation of the oesophagus by flexible endoscopy contributes to an adequate diagnosis. Moreover, it can be used to treat the cause of the obstruction. If dilation therapy is started early after detecting a benign stricture in the oesophagus, it reduces the likelihood of recurrence. The detection of early-stage oesophageal malignancies may improve the prognosis of patients with this disorder.

Acute Disease↗
PubMed2004

Primary esophageal repair for Boerhaave's syndrome whatever the free interval between perforation and treatment.

OBJECTIVES: Boerhaave's syndrome is the most sinister cause of esophageal perforation responsible with mortality rate ranging from 20 to 30%. Combination of mediastinal contamination with microorganisms, gastric acid and digestives enzymes, long free interval between injury and initiation of treatment causes severe mediastinitis which is fatal in most untreated cases. The aim of this paper is to emphasize primary esophageal repair and resuscitation whatever the free interval from rupture and repair. METHODS: A retrospective review of patients treated for Boerhaave's syndrome in our department from January 1980 to February 2003 was performed. The principle of treatment was surgical treatment and avoidance of esophageal exclusion or esophagectomy whichever was possible. RESULTS: There were 25 patients (17 males and 8 females). All patients were operated on by primary esophageal repair, except for three who underwent immediate exclusion of the esophagus and one patient who deceased on arrival before being operated. Patients were classified according to free interval between perforation and treatment: group 1 (n=9; 36%) within the 24 h (range from 12 to 24 h) and group 2 (n=16; 64%) more than 24 h (range from 2 to 17 days). Altogether 6 patients deceased (24%). In hospital mortality rate for groups 1 and 2 was, respectively, 44% (four patients) and 13% (two patients), not significantly different. Mean hospital stay was 63 days. Two patients developed anastomotic leakage needing esophagectomy and retrosternal coloplasty in one or more steps. One patient developed pleural abscess treated by percutaneous drainage. Three patients presented temporary symptomatic esophageal stenosis, of whom one underwent dilation. CONCLUSIONS: Long free interval before treatment does not preclude primary esophageal repair in Boerhaave's syndrome. Esophageal exclusion may be more often than not avoided in most cases.

Adult↗
PubMed2005

[Wide esophageal wall rupture as iatrogenic complication of anterior cervical spine surgery].

The case of 19-year old men with iatrogenic esophageal wall perforation is presented. The patient underwent anterior cervical stabilization using plate and screw for fracture of the C4 and C5 vertebra followed by an abscess of prevertebral space with discharging pus and food from the wound. The general condition was poor. Symptoms included: pneumonia, pleuritis with effusion, septicemia with mediastinitis, fever up to 40 and quadriplegia on neurological examination. During surgical procedure the implant loose but was still fixed into the esophagus causing a large defect in the posterior wall of the hypopharynx and cervical part of esophagus was found. The patient undergone three step surgery with wide drainage of prevertebral abscess, removing of osteosynthetic plate removal and formation of pedicle flap with sterno-cleido-mastoideus muscule. The finnal fourth procedure with using of pediculed infrahyoid flap gave an excellent result. During 160 days hospitalization the pus culture showed growth of the 11 bacterials species (like Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecalis) and 2 species of fungus. He was treated 13 types of antybiotics. This special case we present because of live threatening complication (mediastinitis) and complicated clinical course as well as because of unique technique of the defect closure, i.e. the infrahyoid flap occurred to be successful.

Adult↗