Background: Esophageal perforation is a rare and potentially life-threatening condition requiring urgent management. Successful therapy depends on the underlying etiology, clinical presentation, the time between rupture and diagnosis, the extent of the rupture and the underlying health of the patient. Method: From 2005 to 2012, the author retrospectively analyzed 36 patients treated for esophageal perforation. Data were evaluated for cause of perforation, symptoms, comorbidities, the method of diagnosis, delay in diagnosis, therapeutic regimen, complications, hospital stay, follow-up and mortality. Results: The cause of perforation were iatrogenic in 14 cases (38.8%), foreign body ingestion in 11 (30.5%), spontaneous in 9 (25%), chest trauma in 1 (2.8%) and esophageal cancer in 1 case (2.8%). The most frequent signs and symptoms were chest pain in 27 cases (75%), fever in 15 (41.6%), dysphagia in 11 (30.5%), mediastinitis in 9 (25%) and vomiting in 8 (22%). The treatment included surgery in 26 cases (72.2%) which consists of thoracotomy (right or left), with or without esophageal suturing, washing, drainage with three chest tubes, jejunostomy and gastrostomy. The second group were patients treated medically in 10 cases (27.8%), medical treatment includes nil per os (NPO), parenteral nutrition, intravenous antibiotics and observation. Complications include fever (n = 14), auricular fibrillation (n = 7), esophageal fistula (n = 3), reoperation (n = 2), renal failure (n = 2), cerebrovascular accident (n = 1), pulmonary embolism (n = 1), pneumonia (n = 1) and deep vein thrombosis (n = 1). The average hospital stay for patients treated surgically was 36 days and for patients treated medically was 14.2 days. The overall mortality was 25% involving 8 patients treated surgically and 1 patient treated medically. Conclusion: The treatment method still must be chosen on an individual basis. Rapid diagnosis of this often life threatening condition is critical for expediting the choice of an optimal treatment strategy, whether surgical or non-surgical.
Background: Chylothorax may be primary (spontaneous) or secondary and more often arising as a postoperative complication of thoracic surgery. It occurs when the thoracic duct or its lymphatic tributaries become blocked or perforated or divided resulting in a chylous pleural effusion. Loss of chyle leads to nutritional deficiencies, dehydration, ionic perturbation and lymphocytes leaks thus increasing the vulnerability for infections and respiratory dysfunction. It is a life-threatening complication increasing the postoperative hospital stay. Management of chylothorax is firstly medical which leads to the cessation of leaks in most of the cases. Surgical treatment by thoracic duct ligation is sometimes necessary after failure of medical treatment. The appropriate time for surgical treatment is a subject of controversy. Methods: Reviewing a series of patients treated between 2000 to 2010 in a single center with the same protocol management, the aim of the study was to identify early clinical variables allowing early surgical treatment in postoperative chylothorax. Results: Thirty-two patients were identified in the study period. There were 21 males (65.6%) and 11 females (34.4%) with a mean age of 55.7 years (range from 9 to 79 years) ( Table 1). Twenty-two patients (68.75%) had chylothorax after a surgical intervention, seven patients (21.8%) had chylothorax due to medical causes and three patients (9.3%) after chest trauma. Thirty-eight percent of patients treated conservatively were after lung cancer resection and 35% of patients treated surgically where after esophageal resection. Chylothorax was stopped in 33% of patients after lymphangiography. Cumulative leak per day was 1007 ml/day for operated patients and 397 ml/day for patient treated conservatively. Esophageal resection surgery and the amount of fluid leak were the two factors founded to be associated for the decision of an earlier surgical treatment. Conclusion: Chylothorax arising after esophageal resection with a flow rate of leak of more than 500 ml/day should be proposed to an earlier surgical treatment. Lymphangiography remains a key stone assessment with a double aim diagnostic and therapeutic in chyle leakage. 36 conservative managment, early surgical intervention may be indicated if chest tube drainage is more than 500 mL during the first 24 hours after complete oral intake cessation and total parenteral nutrition.
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