Definitive repair of esophageal perforation is considered the preferred treatment for patients presenting early (<24 hours). However, the optimal management of delayed presentation (>24 hours) has not been well defined. This study examined the management of esophageal perforation and compared the outcomes of early versus delayed presentation. Records of patients admitted with the diagnosis of esophageal perforation were reviewed. Contrast studies were used to confirm the diagnosis in all cases. Patient demographics and outcome were analyzed to determine differences between early and delayed presentation. A total of 22 cases of esophageal perforation were identified (eight early vs 14 delayed presentations). Operative interventions included primary repair (four), reinforced repair (14) either with intercostal muscle or pleural flap, and a complete esophageal resection (one). Debridement and drainage without repair were done in two patients and a proximal intramural tear was treated with antibiotics and observation. Two patients died during hospitalization. All surviving patients had near-normal restoration of esophageal function. Follow-up at 3 years has shown minimal gastrointestinal problems. One patient required repeat esophageal dilatations and two patients underwent antireflux therapy. Esophageal repair should be considered in all cases of nonmalignant esophageal perforation and should not be influenced by the time of presentation.
Volume 5 -Issue 1 placement are felt to develop empyema due to iatrogenic pleural space infection. Primary thoracic empyema refers to pleural empyema in patients without clear evidence of underlying pneumonia or other recognized conditions to explain bacterial invasion to pleural space [6]. Streptococcus intermedius/milleri has been identified as a common pathogen for empyema and lung abscess [7]. The pathogenicity of Streptococcus intermedius/milleri causing empyema without pneumonia is still incompletely understood. Diagnostic thoracentesis and pleural fluid analysis in patients with pleural effusion can help detect complicated effusion early in the course, guide treatment with appropriate antibiotics and pleural space drainage which can prevent progression to empyema, avoid the need for more invasive procedures such as video-assisted thoracoscopy (VATS) or open thoracotomy with debridement and decortication [8]. It is important to note that adequate and complete drainage of empyema is central to effective therapy.
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