Computed Tomography in Patients with Esophageal Perforation

Backer, Carl L.; LoCicero, Joseph; Hartz, Renée S.; Donaldson, James S.; Shields, Thomas W.

doi:10.1378/chest.98.5.1078

Cited by 105 publications

(44 citation statements)

References 4 publications

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“…Recently, we encountered a female patient with empyema whose causative microorganisms included Candida albicans. The patient complained of appetite loss and epigastralgia but did not have a history of vomiting followed by chest pain, nor did she have computed tomography (CT) findings suggestive of esophageal rupture such as esophageal thickening and extraluminal air in the mediastinum (5). Her pleural effusion amylase level at initial thoracentesis was normal, and esophageal rupture was not strongly indicated.…”

Section: Introductionmentioning

confidence: 99%

Isolation of Candida Species is an Important Clue for Suspecting Gastrointestinal Tract Perforation as a Cause of Empyema

Ishiguro¹,

Takayanagi²,

Ikeya

et al. 2010

Intern. Med.

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Background Empyema due to Candida species is a rare entity, and the significance of isolation of Candida species from the pleural effusion is not fully understood. Objective To elucidate the clinical features of Candida empyema. Methods We retrospectively reviewed the cases of 128 patients with culture-positive empyema. Results These 128 patients included 7 whose cause of empyema was esophago-or gastropleural fistula. Empyema was due to Candida species in 5 of the 7 patients. Primary diseases of these 5 patients were spontaneous esophageal rupture in 3 patients, esophageal rupture due to lung cancer invasion in 1 patient, and gastric ulcer perforation in 1 patient. None of these 5 patients had esophageal candidiasis. Among the 121 other patients with empyema not due to esophago-or gastropleural fistula, no patient had empyema due to Candida. Conclusion We believe that the empyema in these 5 patients was caused by normal commensal Candida species entering the pleural cavity when the fistula between the gastrointestinal tract and pleural cavity was formed. Isolation of Candida species can be an important clue for suspecting gastrointestinal tract perforation as a cause of empyema.

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Section: Introductionmentioning

confidence: 99%

Isolation of Candida Species is an Important Clue for Suspecting Gastrointestinal Tract Perforation as a Cause of Empyema

Ishiguro¹,

Takayanagi²,

Ikeya

et al. 2010

Intern. Med.

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“…If it does not identify the site of tear, it will reveal indirect evidence of esophageal perforation such as medastinal air or fluid, pleural effusion, and hydropneumothorax. 9 Aim of management of a case of esophageal perforation should be to resuscitate the patient with adequate volume of fluid by intravenous route, broad spectrum antibiotics should be given to prevent secondary infection followed by timely surgical repair of the tear. 10 The mortality rate in esophageal perforation is 10% with early diagnosis and can be as high as 50% if diagnosed late.…”

Section: Discussionmentioning

confidence: 99%

Boerhaave's syndrome

Maurya

Sharma

Ravikumar

et al. 2016

Medical Journal Armed Forces India

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“…In recent years, diagnostic accuracy has increased due to advances in multidetector computed tomography (MDCT), which can detect small amounts of mediastinal emphysema 11) . However, reports indicate that approximately 10% of cases of spontaneous esophageal rupture show no specific CT features, such as mediastinal emphysema or empyema, and that the perforation site and size can be evaluated by performing esophagography with a water-soluble contrast agent, making it a useful study for a definitive diagnosis 12) . We performed CT in all 10 of our patients and esophagography in 8, and a definitive diagnosis was reached in all cases.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Spontaneous Esophageal Rupture: An Evaluation

Mikami

Fukunaga

Enomoto

et al. 2015

J St. Marianna Univ

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Spontaneous esophageal rupture is rare. The distal esophagus ruptures upon a sudden vomiting-induced increase in the internal esophageal pressure. We evaluated surgical management of spontaneous esophageal rupture by examining clinical details and outcomes of 10 patients treated for the disorder at our hospital between 1987 and 2014.Mean age of the patients was 58.1 years (range, 41-75 years). The sex ratio (M/F) was 9/1. Diagnosis was achieved by chest computed tomography (CT) or chest CT and esophagography. The rupture occurred in the left lower thoracic esophagus (n=8), left middle thoracic esophagus (n=1), or right lower thoracic esophagus (n=1). Mean time from symptom onset to surgery was 36.2 hours (range, 5-96 hours).Patients were divided between those treated within 24 hours of onset (early treatment group, n=5) and those treated 24 hours or more after onset (late treatment group, n=5). Treatment comprised primary repair in 7 patients and esophagectomy in 3. Postoperative complications occurred in 6 patients: surgical site infection (n=4), anastomosis leakage (n=3), intrapleural abscess (n=1), sepsis (n=1), and pneumonia (n=1). Mean postoperative hospital stay was78.5 days (range, 22-228 days). There was no in-hospital mortality.Postoperative complications were somewhat more frequent in the late treatment group (n=4, 80%) than in the early treatment group (n=3, 60%), and postoperative hospital stay was longer in this group (114.2 vs. 42.8 days). Outcomes in terms of postoperative complications and hospital stay were good in the early treatment group. In the late treatment group, severe intrathoracic contamination in 3 patients necessitated life-saving esophagectomy. When primary repair was performed, the incidence of anastomotic leakage was lowest when both layers were sutured, perforation sites were reinforced, and nutritional support was provided.Early diagnosis and treatment are essential for spontaneous esophageal rupture, and we believe that selecting the appropriate surgical technique increases survival.

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Computed Tomography in Patients with Esophageal Perforation

Cited by 105 publications

References 4 publications

Isolation of Candida Species is an Important Clue for Suspecting Gastrointestinal Tract Perforation as a Cause of Empyema

Isolation of Candida Species is an Important Clue for Suspecting Gastrointestinal Tract Perforation as a Cause of Empyema

Boerhaave's syndrome

Surgical Management of Spontaneous Esophageal Rupture: An Evaluation

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