Surgical Treatment of Traumatic Esophageal Perforations. Analysis of 10 Cases

Andrade-Alegre, Rafael

doi:10.1590/s1807-59322005000500005

Cited by 23 publications

(11 citation statements)

References 39 publications

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“…We agree with many authors that for detected early perforations (less than 24 h from injury), the best treatment is primary repair [13][14][15].…”

Section: Discussionsupporting

confidence: 88%

Diagnosis, management and outcomes of thoracic esophageal perforation

Panko¹,

Karpitski²,

Shestjuk³

et al. 2014

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Introduction: Esophageal perforation has been considered a catastrophic and often life-threatening event.Aim of the research: To show the results and difficulties in the management of esophageal perforation based on the experience of our department of thoracic surgery as well as data obtained from other hospitals. Material and methods: We performed a retrospective analysis of the management of 103 patients (mean age: 49.4 ±3.1) treated during the period of 1997-2011. Open surgery historical control group (94 patients) was compared with patients (9 cases) who had undergone video-assisted thoracoscopic surgery nonresection procedure in our hospital. Results: Data analysis has revealed that 32 (31%) of all patients were not recognized as a "thoracic esophageal injury" at the first examination. Despite the fact that more than 80% of patients were hospitalized on the first day, in 42 cases (40.8%), surgical treatment was applied after 24 h (52.1 ±7.8). Sixty-percent patients of control group were complicated by postoperative morbidity resulted in higher (p < 0.05) mortality rate (35.1%) and hospital stay time (41.2 ±6.1 days), then VATS management of patients who had 11.1% postoperative mortality and 26.5 ±5.6 days of hospital stay. Conclusions: Esophageal perforations are rare pathology and due to the rarity of this condition and its often nonspecific presentation, the surgical treatment of it is delayed in more than 40% of patients, which leads to death of every third patient. Video-assisted thoracoscopic surgery with adequate drain perforation has had advantages in comparison with standard open surgical techniques in treatment of patients with delayed perforation and severe inflammatory reaction.

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“…We agree with many authors that for detected early perforations (less than 24 h from injury), the best treatment is primary repair [13][14][15].…”

Section: Discussionsupporting

confidence: 88%

Diagnosis, management and outcomes of thoracic esophageal perforation

Panko¹,

Karpitski²,

Shestjuk³

et al. 2014

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“…A perfuração traumática do esôfago é infreqüente e seu manejo continua sendo um desafio para os cirurgiões 4,6 . .…”

Section: Discussionunclassified

Perfuração de esôfago: análise de 11 casos

Andrade

2008

Rev. Col. Bras. Cir.

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Em seis pacientes (54,5%), a perfuração era no esôfago cervical, quatro (36,4%) no torácico e um (9,1%) no abdominal. A etiologia da lesão foi corpo estranho em cinco casos, arma branca em dois e os outros foram por arma de fogo, dilatação endoscópica, ingestão de substância cáustica e trauma contuso. Diagnóstico e tratamento nas primeiras 24 horas ocorreu em três (27,3%) pacientes e após 24 horas em oito casos (72,7%). O tratamento conservador foi instituído para dois (18,2%), que evoluíram bem e o cirúrgico para nove (81,9%), dentre os quais houve dois óbitos. Conclusão: a perfuração esofágica é grave, mas um tratamento precoce e adequado pode resultar na sobrevida da maioria dos pacientes (Rev. Col. Bras. Cir. 2008; 35(5): 292-297 INTRODUÇÃOAs lesões traumáticas do esôfago apresentam baixa prevalência, porém, alto índice de letalidade principalmente quando seu diagnóstico é tardio. A localização anatômica do esôfago, conferindo-lhe proteção aos agravos externos, justifica a pequena incidência das perfurações desse órgão 1 . Em 6.000 lesões torácicas de grande porte observadas durante a segunda guerra mundial, Coréia e Vietnam, foram diagnosticadas somente 18 lesões esofagianas 2 . A causa mais comum de perfuração esofágica é a perfuração iatrogênica secundária a procedimentos endoscópicos diagnósticos e terapêuticos. Outras etiologias são ruptura espontânea, trauma, ingestão de corpo estranho e, mais raramente, tumores, ingestão de substâncias cáusti-cas, esofagite severa, lesão por medicamento retido e intubação endotraqueal difícil [3][4][5] Existe uma relação direta entre mortalidade e tempo transcorrido entre o momento da perfuração e o diagnóstico. A mortalidade de 10% a 25% é encontrada quando o tratamento é instituído nas primeiras 24 horas e chega a 40 a 60% quando o tratamento é realizado após as 24 horas 1,3 . O avanço tecnológico e melhor suporte peri e pós-operatório aos pacientes críticos têm contribuído para a obtenção de melhores resultados no tratamento das perfurações esofágicas, gerando uma redução da mortalidade nas últimas décadas 5 . Este estudo tem por objetivo fazer uma análise de 11 casos de perfuração esofágica. MÉTODOEste é um estudo retrospectivo de 11 pacientes com perfuração esofágica, atendidos no Pronto Socorro do Hospital Getúlio Vargas em Teresina-PI. Todos os casos foram conduzidos pelo autor deste estudo. As causas das lesões foram corpo estranho (cinco), arma de fogo (um), arma branca (dois), procedimento endoscópico (um), ingestão de substân-cia cáustica (um) e trauma contuso (um). Três pacientes foram tratados até 24 horas após o trauma (tratamento precoce) e oito pacientes tiveram seu diagnóstico e instituição do tratamento em períodos de um a 23 dias de evolução (tratamento tardio). Dois pacientes foram conduzidos de forma conservadora e nove foram submetidos a procedimento cirúrgico. RESULTADOSAs localizações das lesões foram seis (54,5%) em esôfago cervical, quatro (36,4%) em esôfago torácico e um (9,1%) em esôfago abdominal. Das seis perfurações em esôfago cervical,...

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“…The T-tube in conjunction with laparoscopy offers the possibility of lavage and drainage. The T-tube has been described in the literature as an effective treatment for esophageal perforations [29,33]. It has been shown as an alternative in delayed esophageal perforations, achieving a controlled fistula with low mortality and adequate resolution [29].…”

Section: Discussionmentioning

confidence: 99%

T-Tube Gastrostomy as a Novel Approach for Distal Staple Line Disruption after Sleeve Gastrectomy for Morbid Obesity: Case Report and Review of the Literature

et al. 2009

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Laparoscopic sleeve gastrectomy has recently become a feasible option in the management of morbid obesity. One of the most feared complications of this procedure is staple line disruption and leakage. There are, to our knowledge, few literature reports that try to explain the reasons and management of this rare but serious complication. We report a case of staple line disruption that was managed using a T-tube gastrostomy. A 50-year-old female, 2 weeks status post-sleeve gastrectomy in an outside facility, was admitted to the emergency room at Cleveland Clinic Florida with new onset of fever, abdominal pain, jaundice, hematemesis, and melena. A computed tomography scan of the abdomen revealed a large extravasation of contrast material parallel to the gastric sleeve. A diagnostic laparoscopy was performed that showed a distal and proximal disruption of the staple line. A T-tube gastrostomy with a large proximal and distal limb was placed into the most distal area of disruption. After thorough over sewing and drainage of the proximal site and T-tube, a feeding jejunostomy was placed. The T-tube permitted to control the leak and to have a controlled fistula. Four weeks postoperatively, the T-tube was removed after the patient had a negative Gastrografin study and tolerated oral fluids with a clamped T-tube. The long-term recovery and follow-up were uneventful. T-tube gastrostomy appears to be a safe and feasible treatment option for staple line disruption after vertical sleeve gastrectomy. Early detection and drainage remain the most important principles to manage this type of complication.

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Surgical Treatment of Traumatic Esophageal Perforations. Analysis of 10 Cases

Cited by 23 publications

References 39 publications

Diagnosis, management and outcomes of thoracic esophageal perforation

Diagnosis, management and outcomes of thoracic esophageal perforation

Perfuração de esôfago: análise de 11 casos

T-Tube Gastrostomy as a Novel Approach for Distal Staple Line Disruption after Sleeve Gastrectomy for Morbid Obesity: Case Report and Review of the Literature

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