Successful Treatment of Septic Shock due to Spontaneous Esophageal Perforation 96 Hours after Onset by Drainage and Enteral Nutrition

Yamashita, Risako; Takeno, Shinsuke; Yamana, Ippei; Maki, Kenji; Miyake, Toru; Shiwaku, Hironari; Shiroshita, Toyoo; Shiraishi, Takeshi; Iwasaki, Atsushi; Yamashita, Yuichi

doi:10.1159/000369967

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…The result of this research indicates that the use of enteral nutrition during conventional treatment of elderly patients with heart failure helps to maintain patients’ gastrointestinal function, promote protein synthesis, improve patients’ nutrition status, adjust inflammatory cytokine levels, and improve cardiac function. 12 – 14 The longer the treatment period is, the more obvious the improvement in cardiac function and inflammatory cytokine levels will be. Patients on free diet showed no obvious improvement in nutrition indicators after the treatment, the levels of some indicators having even decreased.…”

Section: Discussionmentioning

confidence: 99%

Relationship between enteral nutrition and serum levels of inflammatory factors and cardiac function in elderly patients with heart failure

Zhou

Qian

2018

CIA

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ObjectiveTo investigate enteral nutrition’s effect on serum inflammatory factors and the cardiac function of malnourished elderly patients with heart failure.Patients and methodsA total of 105 elderly patients with heart failure were randomly divided into 3 groups: Treatment Group A, Treatment Group B, and the Control Group (Group C), each group having 35 patients and being administered conventional heart failure treatment. Group A was treated with 500 mL·d−1 of enteral nutrition for 1 month. Group B was given the same dose of enteral nutrition for 3 months. The Control Group was given free diet. Nutritional risk screening 2002 was used to assess the nutritional status before and after the treatment for each group. New York Heart Association status was recorded as were left ventricular ejection fraction, plasma B-type natriuretic peptide, inteleukin-6, C-reactive protein, and tumor necrosis factor-α.ResultsAfter the treatment, the body mass index, skinfold thickness of upper arm triceps, muscle circumference of the upper arm, upper arm muscle circumference, total protein, albumin, hemoglobin, and left ventricular ejection fraction in the treatment groups all increased, with relatively obvious relief of symptoms of heart failure. The levels of B-type natriuretic peptide, interleukin-6, tumor necrosis factor-α, and C-reactive protein all rose to different extents (P<0.05) and Treatment Group B showed more obvious improvement (P<0.01). Differences shown by the Control Group in each nutrition indicator, serum levels of inflammatory factors, and cardiac function had no statistical significance (P>0.05).ConclusionThe use of enteral nutrition in conventional treatment of elderly patients with heart failure could improve not only patients’ nutritional status and cardiac function, but also their immune function, thus reducing the levels of inflammatory factors. The longer the treatment period is, the more obvious the improvement in patients’ cardiac function and inflammatory factors will be observed.

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Section: Discussionmentioning

confidence: 99%

Relationship between enteral nutrition and serum levels of inflammatory factors and cardiac function in elderly patients with heart failure

Zhou

Qian

2018

CIA

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“…Other studies recommend gastric decompression to reduce persistent contamination ( 1 , 3 ). Early enteral nutrition and aggressive debridement and drainage of any infected or nonviable tissue and fluid are critical in the management of esophageal perforations ( 11 , 25 ). In the current study, all patients underwent gastric decompression with either a nasogastric or gastrostomy tube placement due to the increased risk of delayed gastric emptying in critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Esophageal stenting with minimally-invasive surgical intervention for delayed spontaneous esophageal perforation

Chiu¹,

Leow²,

Wang³

et al. 2023

J Thorac Dis

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Background Spontaneous esophageal perforation is a challenging surgical emergency with significant morbidity and mortality, and timely primary repair carries good outcomes. However, direct repair for a delayed spontaneous esophageal perforation is not always feasible and is associated with high mortality. Esophageal stenting can provide therapeutic benefits in the management of esophageal perforations. In this study, we review our experience with placing esophageal stents in combination with minimally-invasive surgical drainage to treat delayed spontaneous esophageal perforations. Methods We retrospectively analyzed patients with delayed spontaneous esophageal perforations between September 2018 and March 2021. All patients were treated using a hybrid approach, including esophageal stenting across the gastroesophageal junction (GEJ) to reduce continued contamination, gastric decompression with extraluminal sutures to prevent stent migration, early enteral nutrition, and aggressive minimally-invasive thoracoscopic debridement and drainage of infected material. Results There were 5 patients with delayed spontaneous esophageal perforation treated with this hybrid approach. The mean duration between symptoms and diagnosis was 5 days, and the interval between symptoms and esophageal stent insertion was 7 days. The median time to oral nutrition and to esophageal stent removal was 43 and 66 days. There was no stent migration or hospital mortality. Three patients (60%) had postoperative complications. All patients were successfully resumed on oral nutrition with esophageal preservation. Conclusions A hybrid approach combining endoscopic esophageal stent placement with extraluminal sutures to prevent stent migration, thoracoscopic decortication with chest tube drainage, gastric decompression, and jejunostomy tube placement for early nutrition was feasible and effective in the treatment of delayed spontaneous esophageal perforations. This technique offers a less invasive treatment approach for a challenging clinical problem which has traditionally carried a high rate of morbidity and mortality.

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“…Other authors have noted unusual symptoms such as epigastric pain or interscapular back pain that progressed to chest pain and dysphagia. 8 They suggested that chest pain after sustained strain may be indicative of esophageal perforation. 9,10 Although barium esophagography has up to 10% false-negative results, it is the standard method for diagnosis of esophageal perforation.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of early and late esophageal perforation

Masoom

Dalouee

Fattahi

et al. 2018

Asian Cardiovasc Thorac Ann

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Introduction Esophageal perforation is a rare and life-threating problem with a 10%–40% mortality rate. Early diagnosis and treatment are important for prevention of complications. Strategies for treatment of esophageal perforation have been controversial for many years, especially in cases of late presentation. Methods We prospectively studied 27 patients (12 male, 17 female, mean age 42.7 ± 17.8 years) who presented with esophageal perforation from 1996 to 2015, and evaluated the results of surgical treatment. The patients were divided into 3 groups according to time of presentation: early (<24 h), intermediate (24–72 h), and late (>72 h). We also considered the etiology and site of esophageal perforation, complications, and mortality. Results Surgery was performed in 5 patients in the early group, 7 in the moderate group, and 15 in the late group. Primary repair was carried out in 5 cases, primary repair and reinforcement with a flap in 10, esophageal resection and reconstruction in 8, and a T-tube stent was used in 4. Four patients developed a fistula postoperatively, and there was one death due to respiratory failure. No relationship was found between complications and the cause of perforation, time of presentation, or type of treatment. Conclusion In patients without sepsis, primary repair can be an option even in those presenting late after esophageal perforation, with an acceptable result.

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Successful Treatment of Septic Shock due to Spontaneous Esophageal Perforation 96 Hours after Onset by Drainage and Enteral Nutrition

Cited by 5 publications

References 11 publications

Relationship between enteral nutrition and serum levels of inflammatory factors and cardiac function in elderly patients with heart failure

Relationship between enteral nutrition and serum levels of inflammatory factors and cardiac function in elderly patients with heart failure

Esophageal stenting with minimally-invasive surgical intervention for delayed spontaneous esophageal perforation

Surgical management of early and late esophageal perforation

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