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Three cases of esophageal perforation treated successfully with plastic stents and clips
D. Kapetanos,G. Kokozidis,T. Maris,A. Ilias
Annals of Gastroenterology , 2009,
Abstract: Esophageal perforation is a clinical condition that in the past was usually managed with surgical intervention. The application of clips and self-expanding removable plastic stents facilitated conservative treatment of esophageal perforation. Here we present 3 cases with esophageal perforation treated with self-expanding plastic stents or clips.
Perfura o esofágica em trauma cervical fechado Esophageal perforation in closed neck trauma  [cached]
Agnaldo José Graciano,Adrian Maurício Stockler Schner,Carlos Augusto Fischer
Brazilian Journal of Otorhinolaryngology , 2013,
Delayed presentation of intrathoracic esophageal perforation after pneumatic dilation for achalasia  [cached]
Ming-Tzung Lin, Wei-Chen Tai, King-Wah Chiu, Yeh-Pin Chou, Ming-Chao Tsai, Tsung-Hui Hu, Chuan-Mo Lee, Chi-Sin Changchien, Seng-Kee Chuah
World Journal of Gastroenterology , 2009,
Abstract: Pneumatic dilation (PD) is considered to be a safe and effective first line therapy for achalasia. The major adverse event caused by PD is esophageal perforation but an immediate gastrografin test may not always detect a perforation. It has been reported that delayed management of perforation for more than 24 h is associated with high mortality. Surgery is the treatment of choice within 24 h, but the management of delayed perforation remains controversial. Hereby, we report a delayed presentation of intrathoracic esophageal perforation following PD in a 48-year-old woman who suffered from achalasia. She completely recovered after intensive medical care. A review of the literature is also discussed.
Traumatic upper cervical esophageal perforation in childhood with door handle
E Mammadov, A Alim, M Elicevik, S Celayir
Annals of Pediatric Surgery , 2011,
Abstract: Cervical esophageal rupture due to trauma in childhood is an extremely rare entity associated with a high rate of morbidity and mortality if misdiagnosed. There is still no consensus on the assessment and elective management of children with trauma and esophageal rupture. Surgical primary repair is usually not feasible in patients with delayed diagnosis, especially if the period extends over 48 h. We report a case of an 8-year-old boy who suffered a posterior oropharyngeal and cervical esophageal perforation after accidental intraoral penetration of a door handle. Primary repair was avoided because of late presentation of the patient. In nearly 1 months, the perforation resolved completely without surgical intervention to the primary site.
Candida esophageal perforation and esophagopleural fistula: a case report
Baha Al-Shawwa, Lynn D'Andrea, Diana Quintero
Journal of Medical Case Reports , 2008, DOI: 10.1186/1752-1947-2-209
Abstract: We report the youngest pediatric case in the medical literature of spontaneous esophageal perforation and an esophagopleural fistula due to Candida infection.A high index of suspicion, especially in the presence of Candida empyema and the absence of disseminated infection, should raise the possibility of esophageal perforation with esophagopleural fistula formation. This can lead to early diagnosis and surgical intervention, which would decrease the high mortality rate of this rare condition.Esophageal perforation is a rare and usually life-threatening disease, especially in children. A delay in diagnosis and management worsens the outcome and increases the risk of complications [1]. Esophageal perforation usually occurs with the use of endoscopic instruments, or in relation to surgical thoracic procedures, trauma or foreign bodies. Spontaneous esophageal rupture rarely occurs unless it is associated with forceful episodes of vomiting (Boerhaave syndrome) [2].Esophegeal perforation should be suspected on the basis of clinical presentation of sudden chest pain, fever, vomiting and subcutaneous emphysema. However, in children the presentation of esophageal perforation can mimic many disease processes, such as pneumonia, lung abscess and sepsis, especially in patients with multiple medical problems. Therefore, a high index of suspicion is required [3].In this case report we present a patient with a spontaneous esophageal perforation that was associated with Candida infection and complicated by an esophagopleural fistula (EPF).The patient was a 7-year-old boy with a complex medical history including prematurity, as well as holoprosencephaly, congenital absence of the corpus callosum and hydrocephalus. A shunt malfunction at 6 years of age left him with severe neurological impairment. After this event, he required a tracheotomy for long-term ventilatory support and a gastrostomy tube for nutritional support. He was also being treated for gastro-esophageal reflux disease.
Esophageal Perforation in Children: Experience in Kurdistan Center for Gastroenterology and Hepatology/Iraq  [PDF]
Adnan M. H. Hamawandi, Aram Baram, Ali A. G. Ramadhan, Taha A. Karboli, Abdulsalam Y. Taha, Ako Anwar
Open Journal of Gastroenterology (OJGas) , 2014, DOI: 10.4236/ojgas.2014.45033
Abstract: Background: Esophageal perforation is a rare, but potentially life threatening injury. The etiology and management of this condition have changed overtime. Iatrogenic causes are increasingly recognized and management is evolving towards more conservative approaches. Objective: To review our experience in the management of esophageal perforation in pediatric patients. Patients and methods: This retrospective study was conducted in the Kurdistan center for gastroenterology and hepatology in Sulaimani city. Review of records for cases of esophageal perforation during the period from January 2006 to October 2013 was performed. Results: Ten cases were found to have esophageal perforation. The causes of esophageal perforation were complications of endoscopic dilation for esophageal stricture (n = 7), button battery ingestion (n = 2), complication of esophagoscopy for corrosive injury (n = 1). The mean age was 42 months (range, 18 - 75 months). The diagnosis was made during the procedure in 6 cases, within 12 hours in 2 cases and late in the two cases of battery ingestion. Subcutaneous emphysema and respiratory distress were the main presenting features. The location of perforation was thoracic in 9 cases and cervical in 1 case. Conservative management was successful in 7 patients and surgical closure was done in two patients. One death has been reported. Conclusion: Iatrogenic causes were the most common causes of esophageal perforation. Conservative management with interventions guided by clinical response can have a favorable outcome and may become the best initial treatment strategy in the future. Further larger scale studies are recommended to establish the best protocol for conservative management.
Esophageal perforation caused by external air-blast injury
Jun-Neng Roan, Ming-Ho Wu
Journal of Cardiothoracic Surgery , 2010, DOI: 10.1186/1749-8090-5-130
Abstract: We review the literature and report a case of esophageal perforation caused by external air-blast injury.Including the present case, a total of 5 cases of esophageal perforation were caused by external air-blast injury in English literature. Of them, the common presentations were chest pain and dyspnea. The treatment methods varied with each case. One patient died before diagnosis of esophageal perforation and the others survived after proper surgical management.Early diagnosis and proper surgical management can reduce the morbidity and mortality of patients who suffered from esophageal perforation caused by external air-blast injury.Esophageal perforation caused by air-blast injury is uncommon. An external air impact on the chest wall and upper abdomen, inducing rupture of the esophagus, is an even rare event. Only four cases of esophageal rupture caused by an external air-blast injury were found in a perusal of the English literature [1-4]. The objective of this article is to report our patient and a review of the literature to establish diagnostic and treatment strategies for esophageal perforation after an external air-blast injury.A 31-year-old man was struck on the right side of the face and left subcostal region at work when a nitrogen tank exploded four hours after he had eaten his lunch. He was knocked down to the ground and dazed, without loss of consciousness. He was immediately sent to the emergency department with a presentation of left chest pain and dyspnea. His vital signs were stable on arrival. An emergency left tube thoracostomy was performed, because his left-sided breath sounds had decreased, with a suspicion of pneumothorax. Ecchymosis and tenderness were detected on the left lower chest, without peritoneal signs. The patient was admitted for further observation and was allowed to intake thereafter. Esophageal rupture was not diagnosed until 84 hours after the injury when the tomato juice the patient had ingested was found in the chest bottle.
Cervical cellulitis and mediastinitis following esophageal perforation: A case report  [cached]
Christian A Righini, Basilide Z Tea, Emile Reyt, Karim A Chahine
World Journal of Gastroenterology , 2008,
Abstract: Chicken bone is one of the most frequent foreign bodies (FB) associated with upper esophageal perforation. Upper digestive tract penetrating FB may lead to life threatening complications and requires prompt management. We present the case of a 52-year-old man who sustained an upper esophageal perforation associated with cervical cellulitis and mediastinitis. Following CT-scan evidence of FB penetrating the esophagus, the impacted FB was successfully extracted under rigid esophagoscopy. Direct suture was required to close the esophageal perforation. Cervical and mediastinal drainage were made immediately. Naso-gastric tube decompression, broad-spectrum intravenous antibiotics, and parenteral hyperalimentation were administered for 10 d postoperatively. An esophagogram at d 10 revealed no leak at the repair site, and oral alimentation was successfully reinstituted. Conclusion: Rigid endoscope management of FB esophageal penetration is a simple, safe and effective procedure. Primary esophageal repair with drainage of all affected compartments are necessary to avoid life-threatening complications.
Esophageal perforation in South of Sweden: Results of surgical treatment in 125 consecutive patients
Michael Hermansson, Jan Johansson, Tomas Gudbjartsson, G?ran Hambreus, Per J?nsson, Ramon Lillo-Gil, Ulrika Smedh, Thomas Zilling
BMC Surgery , 2010, DOI: 10.1186/1471-2482-10-31
Abstract: 125 consecutive patients treated at the University Hospital of Lund from 1970 to 2006 were studied retrospectively. Prognostic factors were evaluated using the Cox proportional hazards model.Pre-operative ASA score was the only factor that significantly influenced outcome. Neck incision for cervical perforation (n = 8) and treatment with a covered stent with or without open drainage for a thoracic perforation (n = 6) had the lowest mortality. Esophageal resection (n = 8) had the highest mortality. A CAT scan or an oesophageal X-ray with oral contrast were the most efficient diagnostic tools. The preferred treatment strategy changed over the course of the study period, from a more aggressive surgical approach towards using covered stents to seal the perforation.Pre-operative ASA score was the only factor that significantly influenced outcome in this study. Treatment strategies are changing as less traumatic options have become available. Sealing an esophageal perforation with a covered stent, in combination with open or closed drainage when necessary, is a promising treatment strategy.A perforation of the oesophagus implies a serious therapeutic problem. If a mediastinitis develops the situation can become life threatening in a few hours. Strategies for aiding patients struck with this disease are changing as new and less traumatic treatment options are developing. The introduction of covered metallic esophageal stents (SEMS) has offered a less traumatic alternative. In this situation, when new methods are evaluated, it is important to have knowledge about how these patients have been treated in the past.Treatment of esophageal perforations remains controversial and no consensus has been reached on the best treatment option. This is a reflection of the fact that this condition is difficult to study with a high degree of scientific power. The incidence of esophageal perforation is low and limited clinical materials are still reported. In 1997 when Brauer and co-worker
A Rare Association of Congenital Diaphragmatic Hernia with Lower Esophageal Atresia and Perforation  [PDF]
Narendra Kumar Are,K. Nagarjuna,Lavanya Kannaiyan
International Journal of Pediatrics , 2010, DOI: 10.1155/2010/738546
Abstract: Congenital diaphragmatic hernia is known to be associated with esophageal atresia, which is a rare association. We report a rare occurrence of congenital diaphragmatic hernia and lower esophageal atresia. 1. Introduction Abnormalities of the esophagus such as gastroesophageal reflux disease (GERD), esophageal motility disorders, esophageal duplications cysts, and tracheoesophageal fistula with esophageal atresia are rare but documented occurrences with congenital diaphragmatic hernia [1, 2]. We report a rare association of lower esophageal atresia with congenital diaphragmatic hernia (CDH). 2. Case Report A 10-day male child presented with respiratory distress without cyanosis since birth. On clinical examination, patient had tachypnea, with a scaphoid abdomen. The persistent drooling of saliva led to the suspicion of esophageal atresia. A red rubber catheter was passed into the esophagus, but there was resistance at 15?cm from the alveolar margin. Chest X-ray showed evidence of left CDH with mediastinal shift and the tip of nasogastric tube at the level of the diaphragm. A contrast esophagogram was done which showed holdup of dye at the level of the diaphragm (Figure 1). With the suspicion of associated esophageal obstruction and CDH, a laparotomy was done using a chevron incision. The operative findings include left posterolateral CDH, complete disruption of the esophagogastric junction with a blind-ending esophagus, and a sealed esophageal perforation at the esophagogastric junction (Figure 2). Figure 1: Contrast esophagogram showing holding up (arrow) of contrast at the level of the diaphragm with evidence of CDH with lower esophageal obstruction. Figure 2: Operative photograph showing a blind ending of the lower esophagus with a sealed perforation (arrow). The surgical correction included repair of CDH and esophagogastric anastomosis with a feeding jejunostomy. The postoperative course was uneventful. Jejunostomy feeds were started on the 4th postoperative day. Contrast esophagogram was done on the 10th postoperative day. It showed free flow of dye into the stomach. At discharge, the child was on full oral feeds. He has been followed up for 3 months. The child’s general condition is good with adequate weight gain. 3. Discussion Esophageal anomalies are known to be associated with CDH. These associations include tracheoesophageal fistula with esophageal atresia, GERD, esophageal dysmotility, esophageal duplication cysts, and esophageal ectasia [1, 2]. The possible noted explanations include the kinking of the esophagogastric junction [2] and
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