Personal management of 57 consecutive patients with esophageal perforation

Gupta, Nidhi; Kaman, Lileswar

doi:10.1016/j.amjsurg.2002.11.004

Cited by 200 publications

(206 citation statements)

References 31 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: Discussionmentioning

confidence: 45%

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: Discussionmentioning

confidence: 45%

Diagnosis, management and outcomes of thoracic esophageal perforation

Panko¹,

Karpitski²,

Shestjuk³

et al. 2014

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“…Etiology and treatment are summarized in Table 1. The mean hospital stay was 9.3 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) days in the early presented and 68.3 (16-300) days in the delayed presented group.…”

Section: Resultsmentioning

confidence: 99%

“…Based on our experience and based on available literature [6,9,11,12,16], we created a treatment algorithm for our hospital (Fig. 1).…”

Section: Early Presentation <24hmentioning

confidence: 99%

Treatment of Early and Delayed Esophageal Perforation

et al. 2012

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Esophageal perforations are life threatening emergencies associated with high morbidity and mortality. We report on 22 consecutive patients (age 20-86; 13 female and 9 male) with an oesophageal perforation treated at the university hospital Duesseldorf. The patients' charts were reviewed and follow-up was completed for all patients until demission, healed reconstruction or death. Patients' history, clinical presentation, time interval to surgical presentation, and treatment modality were recorded and correlated with patients' outcome. Six esophageal perforations were due to a Boerhaave-syndrome, eleven caused by endoscopic perforation, two after osteosynthesis of the cervical spine and three foreign body induced. In 7 patients a primary local suture was performed, in 4 cases a supplemental muscle flap was interposed, and 7 patients underwent an oesophageal resection. Four patients were treated without surgery (three esophageal stent implantations, one conservative treatment). Eleven patients (50 %) were presented within 24 h of perforation, and 11 patients (50 %) afterwards. Time delay correlates with survival. In 17 (80.9 %) cases a surgical sufficient reconstruction could be achieved. One (4.7 %) patient is waiting for reconstruction after esophagectomy. Four (18.2 %) patients died. A small subset of patients can be treated conservatively by stenting of the Esophagus, if the patient presents early. In the majority of patients a primary repair (muscle flap etc.) can be performed with good prognosis. If the patient presents delayed with extensive necrosis or mediastinitis, oesophagectomy and secondary repair is the only treatment option with high mortality.

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“…He did not require surgical repair of the pharyngeal defect and was discharged from the hospital 2 weeks later. Pharyngeal perforation usually results not only from iatrogenic injury, but may also be due to foreign body ingestion or barotrauma [1]. Subcutaneous emphysema may be subtle and a delay in diagnosis is possible, carrying a slightly higher mortality compared to cases that are diagnosed early [2].…”

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confidence: 99%

A man with drug-induced psychosis attempts to swallow his cellular phone

et al. 2013

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A 35 year-old man with no significant past medical history presented to the emergency department (ED) after abusing phencyclidine (PCP). Responding to command auditory hallucinations, he attempted to swallow his 4 cm 9 8 cm smartphone. On arrival, he was agitated but alert, handling his secretions poorly and in moderate respiratory distress. An electronic device was clearly protruding from his oropharynx. He was tachypneic (24 respirations/min) with an oxygen saturation of 92 % on room air, a heart rate of 131 beats per minute and a blood pressure of 137/64 mmHg.Emergency physicians immediately attempted to remove the device with Magill forceps, but were unsuccessful. A ''trauma code'' was announced bringing a surgical intensivist, an anesthesiologist, and appropriate nursing staff to the bedside, while simultaneously indicating that an operating room (OR) should be prepared. The patient was emergently transported to the OR and ''double prepped'' for both emergent cricothyrotomy and oropharyngeal intubation. The device was successfully removed under procedural sedation without the need for surgical intervention. A mucosal tear was noted in the posterior pharynx. The patient became markedly agitated post-procedure, and, given the recent trauma, was intubated for airway protection. He subsequently developed bilateral pneumothoraces and significant subcutaneous emphysema throughout his neck and upper torso.Diagnosis: Posterior pharyngeal rupture and bilateral pneumothoraces following attempted foreign body ingestion (Fig. 1). Computerized tomography of the neck and chest revealed a defect in the posterior wall of the oropharynx at the C2 level, along with significant mediastinal air and right-greater-than-left pneumothoraces. The patient was treated with a right-sided chest tube and was observed in the intensive care unit. He was treated for 7 days with broad-spectrum antibiotics, specifically, piperacillin and tazobactam. He did not require surgical repair of the pharyngeal defect and was discharged from the hospital 2 weeks later.

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Personal management of 57 consecutive patients with esophageal perforation

Cited by 200 publications

References 31 publications

Diagnosis, management and outcomes of thoracic esophageal perforation

Diagnosis, management and outcomes of thoracic esophageal perforation

Treatment of Early and Delayed Esophageal Perforation

A man with drug-induced psychosis attempts to swallow his cellular phone

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