Case Of Esophageal Perforation Research Articles

A Case of Esophageal Perforation by a Fish Bone Successfully Treated with a Transcervical Approach

A Case of Esophageal Perforation by a Fish Bone Successfully Treated with a Transcervical Approach

A Case of Esophageal Perforation due to a Fish Bone that Led to an Abscess inside the Esophageal Wall

下咽頭・食道異物は穿孔を合併することがあり，穿孔部位から感染を引き起こす注意すべき疾患である。穿孔を合併する症例はCTにて異物を指摘できることがほとんどである。今回，CT検査にて魚骨異物を認めず，その後穿孔から膿瘍まで進展し，直視鏡下にドレナージ術を施行し治癒せしめた1症例を経験したので報告する。症例は79歳女性である。イシモチ (魚) を食べた後，持続する咽頭痛・嚥下時痛にて当院に紹介された。軟性内視鏡検査やCT画像にて異物を疑わせる所見はなかった。その後広範な縦隔気腫にて再診された。保存的治療にて食道壁内膿瘍に進展したため，最終的に直視鏡下にドレナージ術を行い治療した。CT画像上異物を認めなくても，経過の思わしくない症例や気腫を疑い得る症例は，穿孔の可能性ありと疑って診療すべきと考えた。穿孔からの膿瘍も症例を選べば経管的なドレナージ術によって治療できると考えた。

Treatment for esophageal perforations: analysis of 11 cases

We present 11 cases with esophageal perforations who were treated in our department, with the intent of underlining the importance of surgical intervention. We retrospectively analyzed 11 cases of esophageal perforation who were treated from 2005 to 2010. The cases diagnosed within the first 24 hours were regarded as early diagnoses; those diagnosed later than this period were regarded as late diagnoses. The mean age of the patients was 45.8 years. Following the perforation, 3 of the patients had early diagnoses and the others had late diagnoses. Of the 3 cases with early diagnosis, all had primary repair; of the late diagnosis cases, 4 had primary repair, 2 had colonic interposition, 1 had stent implantation, and 1 received medical treatment. All the cases with late diagnoses underwent drainage. The 3 cases who received early treatment recovered without complications. Of the other 8 cases, 1 had leakage from the anastomosis and 1 developed a fistula. Two (18.1%) of our patients died. Treatments performed before the development of mediastinitis are lifesaving in esophageal perforation patients. We think that surgical treatment performed within the first 72 hours that includes primary repair would yield favorable results.

TRANSIENT UNILATERAL VOCAL CORD PARALYSIS DURING ENDOSCOPIC ULTRASOUND

To the Editor, Endoscopic ultrasound (EUS) is generally a safe procedure. However, the longer, rigid tip of the echoendoscopes raises concern about cervical esophageal perforation during intubation.1 Iatrogenic injury of the recurrent laryngeal nerve is the most common cause of vocal cord paralysis.2 We report a case of esophageal perforation and vocal cord paralysis associated with EUS. A 67-year-old man was referred to our hospital because of progressive dysphagia. The endoscopic ultrasound revealed a normal esophagus. The patient developed neck pain and painful swelling after the examination. Physical examination demonstrated that it was not cervical crepitus, and neck radiograph revealed air in the retropharyngeal space. Indirect laryngoscopy showed paralysis of the right vocal cord. The left vocal cord was normal with no ulceration or growth. Assessment and diagnosis of the vocal cord paralysis by otorhinolaryngologists after EUS included interviews and flexible fiberscopy. There were no previous clinical symptoms of neuropathy and no positive history for inherited neuropathies. Computed tomography (CT) scan of the neck and thorax showed perforation of the right pyriform sinus and the presence of a right-sided large laryngocele. Oral intake was withheld and high-dose antibiotics and prednisone (40 mg/day) were administered through the central venous system over 10 days. The patient reported that voice quality and perforation improved suddenly after 10 days of medication. Subsequent laryngoscopy and flexible fiber optic endoscope showed normal movement of the left vocal cords. Control CT scan of the neck and chest obtained 10 days after the first one did not show gas or fluid collection in the right pyriform sinus. Oral intake was restarted on the 10th day and the patient was discharged on the 11th day. EUS have become important tools in evaluation of patients who have various gastrointestinal and non-gastrointestinal disorders, and are being increasingly utilized at many centers.3 EUS is generally a safe procedure. Complications can occur but are rare.2 Vocal cord paralysis may occur for many reasons. The most common cause of esophageal perforation is injury to the esophagus during a medical procedure, such as intubation with inadvertent placement of the tracheal tube in the esophagus, nasogastric tube placement, upper gastrointestinal endoscopy and transesophageal echocardiograph.4 To our knowledge, this is the first reported case of vocal cord paralysis in a patient undergoing EUS. The cause of the complication was damage to the right recurrent laryngeal nerve, which occurred during insertion of the EUS into the esophagus.

Esophageal perforation caused by external air-blast injury

BackgroundEsophageal perforation after external air-blast trauma is rarely presented in the emergency room. The diagnosis is often delayed more than 24 hours.MethodsWe review the literature and report a case of esophageal perforation caused by external air-blast injury.ResultsIncluding the present case, a total of 5 cases of esophageal perforation were caused by external air-blast injury in English literature. Of them, the common presentations were chest pain and dyspnea. The treatment methods varied with each case. One patient died before diagnosis of esophageal perforation and the others survived after proper surgical management.ConclusionsEarly diagnosis and proper surgical management can reduce the morbidity and mortality of patients who suffered from esophageal perforation caused by external air-blast injury.

A case of esophageal perforation with pneumomediastinum by a fish bone (Chromis notata) impaction

Although esophageal perforation due to foreign body is uncommon, it is a lethal problem that requires careful management because of severe complications such as mediaslinilis, empyema, tracheobronchial fistula and retroperitoneal abscess. A 77-year-old man suddenly developed right upper quadrant pain after eating fish (Chromis notata) in the morning the day before admission. Upper endoscopy revealed a 4 cm-sized fishbone impaction and it was removed by a biopsy forcep. Esophageal perforation was found at the middle esophagus. Chest computed tomography showed pneumomediastinum in the left paraaortic area, paraesophageal area, and retrothyroid area. The patient was treated with total parenteral nutrition and broad spectrum intravenous antibiotics. On the seventh day of admission, he was completely recovered and esophagogram showed no leakage of contrast dye. We report an esophageal perforation and pneumomediastinum by a fishbone (Chromis notata) impaction as popular local dish in Jeju island, which was treated successfully with conservative management.

Retraction Note to: Conservative management for an esophageal perforation in a patient presented with delayed diagnosis: a case report

Esophageal perforation is a serious condition with a high mortality rate. Successful therapy depends on the size of the rupture; the time elapsed between rupture and diagnosis, and the underlying health of the patient. Common causes of esophageal perforation include medical instrumentation, foreign-body ingestion, and trauma. A case of esophageal perforation due to fish bone ingestion in a 67-year-old male is described here, with a review of the pertinent literature. The patient presented with chest pain, fever and right-sided pleural effusion. Initial evaluation was nondiagnostic. The water-soluble contrast swallow test showed no evidence of leakage. Computed tomography scan demonstrated a pneumomediastinum, and right-sided hydropneumothorax. The patient was successfully treated using conservative measures.

Low Mortality After Treatment for Esophageal Perforation: A Single-Center Experience

Historically, esophageal perforation has been associated with significant mortality. Improvements in diagnosis, critical care, and surgical and endoscopic techniques may lead to lower mortality rates in the modern era. We reviewed our experience with the management of esophageal perforation to determine whether outcomes have improved. We retrospectively reviewed all cases of esophageal perforation from 1997 through 2008 at our institution. Univariate and propensity-matching analysis were performed. We reviewed the charts of 147 patients, and 97 met eligibility criteria. There were 45 women, (46.4%); mean age was 60.7 ± 15.6 years. Etiologies included iatrogenic in 50 (51.6%), spontaneous in 23 (23.7%), and idiopathic in 22 (22.7%). Treatment within 24 hours of presentation occurred in 55.2% of patients; 22.7% of patients were septic on presentation. Treatment included surgery in 72 patients (74.2%) and nonoperative management in 25 (25.8%). Forty-one patients (42.3%) underwent primary repair, 5 (6.9%) underwent esophageal resection, 4 (5.6%) underwent exclusion, and 22 (22.7%) underwent drainage or stent placement. Thirty-day mortality rate for the entire cohort was only 8.3% (8 patients). The mortality rate for the primary repair patients was 7.7%, and none of the resection patients died. There was similar in-hospital mortality rate between operative and nonoperative treatment groups (p = 0.96). Propensity-matching analysis showed equal morbidity (p = 0.74) and 30-day mortality (p = 0.35) between operative and nonoperative treatment groups. Our study represents a large series of patients treated for esophageal perforation. The results demonstrate that the overall mortality from esophageal perforation can be less than 10%. Primary repair should be considered as first-line treatment when appropriate even in patients who present more than 24 hours after perforation. Nonoperative management, in appropriate patients, can also lead to good success rates and low mortality.

Management of Cervical Esophageal Injury After Spinal Surgery

Esophageal injury is a rare but catastrophic complication of anterior cervical spine surgery. Cases of esophageal perforation may be discovered intraoperatively, or as late as 10 years after surgery. In the current study we aim to review the principles of care and provide an algorithm that can be employed for successful management of this complex problem. We performed a retrospective, Institutional Review Board-approved review of esophageal injuries resulting from anterior cervical spine surgery that were managed at our institution between January 1, 2007 and July 31, 2009. We collected demographic information, perioperative data, and final outcomes. Data were analyzed using descriptive statistics. We identified 6 patients who met our criteria. All patients presented with esophageal leaks, neck abscesses, and osteomyelitis. Similarly, all had been treated prior to transfer, without resolution of their leak. After debridement, removal of hardware, long-term antibiotic therapy, maximization of nutrition, and supportive care, 80% of patients resumed oral intake (median time 66.5 days). Mortality was 16.7%. Neck exploration with removal of hardware, debridement, and open neck wound management are the basic principles of care. Management is often prolonged and requires multiple procedures; however, with persistence, closure is possible in the majority of patients. Our report serves as a guide for the treatment of this devastating problem.

Repair of esophageal perforation due to anterior cervical spine instrumentation

The complication of esophageal perforation after anterior cervical spine fusion for cervical spine disease is rare but potentially fatal. We describe two cases of esophageal perforation found by esophagoscopic visualization. In one patient, primary closure could not be achieved, and a submental island flap was used to repair the defect. In the second patient, primary closure was achieved and a pectoralis major flap was interposed between the closure and the residual instrumentation. Postoperatively, both patients had no evidence of persistent perforation and had resolution of preoperative symptoms.

RETRACTED ARTICLE: Conservative management for an esophageal perforation in a patient presented with delayed diagnosis: a case report

BackgroundEsophageal perforation is a serious condition with a high mortality rate. Successful therapy depends on the size of the rupture; the time elapsed between rupture and diagnosis, and the underlying health of the patient. Common causes of esophageal perforation include medical instrumentation, foreign-body ingestion, and trauma.Case reportA case of esophageal perforation due to fish bone ingestion in a 67-year-old male is described here, with a review of the pertinent literature. The patient presented with chest pain, fever and right-sided pleural effusion. Initial evaluation was nondiagnostic. The water-soluble contrast swallow test showed no evidence of leakage. Computed tomography scan demonstrated a pneumomediastinum, and right-sided hydropneumothorax.ConclusionThe patient was successfully treated using conservative measures.

Thoracic osteophyte: rare cause of esophageal perforation

Esophageal perforation is a difficult problem in thoracic surgery. Esophageal perforations can be spontaneous, iatrogenic, or malignant. We report two cases of esophageal perforations caused by thoracic osteophytes and different management strategies leading to successful outcomes. An 80-year-old male presented with chest pain and dysphagia following a fall. On endoscopy, an esophageal perforation and foreign body was noted which was confirmed as a thoracic osteophyte on computed tomography scan. He was managed conservatively as he declined surgery. A 63-year-old male was admitted with dysphagia following a food bolus obstruction. Following esophagoscopy and dilatation, there was clinical and radiological evidence of perforation. During surgery, a thoracic osteophyte was identified as the cause of perforation. The perforation was closed in layers and the osteophyte was trimmed. Both patients recovered well. Thoracic osteophytes are a rare cause of esophageal perforations and a high index of suspicion is required in patients with osteoarthritis who present with esophageal perforations.

Esophageal tear in a patient undergoing stereotactic brain biopsy under general anesthesia

Injuries of the esophagus with resultant mediastinitis have been reported following endotracheal intubation. Herein, we report a case of esophageal perforation that resulted from difficulty with intubation in a patient with a stereotactic head frame. A 52-year-old woman underwent a stereotactic brain biopsy of a left temporal tumor. After a stereotactic head frame was applied, intubation for anesthesia required three attempts. On postoperative day 2, she complained of worsening dysphagia and chest pain. A 4-mm tear in the right posterior cervical esophagus was discovered and repaired. Esophageal perforation may arise from limited neck extension imposed by a stereotactic head frame. Unexplained dysphagia postoperatively is the hallmark of this rare complication.

Spinal Epidural Abscess Presenting with Paraplegia Following Delayed Presentation of Traumatic Esophageal Perforation without Spinal Fracture: Lessons to be Learnt.

We describe a case of esophageal perforation following blunt chest trauma with delayed presentation as paraplegia secondary to spinal epidural abscess formation. The case highlights the importance of the awareness of the possibility of esophageal injury in patients following road traffic collisions.

Thirty-four cases of esophageal perforation: the experience of a district general hospital in the UK

Esophageal perforation is uncommon and traditionally has a high rate of morbidity and mortality. Our aim was to perform a 13-year retrospective review of the cases managed in our district general hospital. Thirty-four cases of esophageal perforation diagnosed between 1995 and 2008 were retrospectively analyzed. There were 20 males and 14 females with a median age of 64 (range 23-86) years. The etiology of the perforations were Boerhaave's syndrome (n= 19), therapeutic endoscopy (n= 9), diagnostic endoscopy (n= 2), gastric lavage injury (n= 1), foreign body (n= 1), blunt chest trauma (n= 1), and spontaneous tumor perforation (n= 1). Only 11 cases (32%) had evidence of surgical emphysema upon examination. In 50% of cases, another clinical diagnosis was initially suspected. Twenty-four were treated surgically and 10 cases managed non-operatively. Surgical treatment included thoracotomy with primary repair (n= 9), T-tube drainage (n= 7), emergency esophagectomy (n= 1), or intra-operative stent insertion (n= 1). Four cases had primary repair and fundal wrap via abdominal approach without thoracotomy. Two patients were treated with washout and drainage only. Eight patients died overall (in-hospital mortality 23.5%). Esophageal perforations are often initially misdiagnosed and the majority do not have surgical emphysema. There are a wide variety of methods to manage esophageal perforation. Management tailored to the location and size of perforation, degree of contamination, and underlying cause appears to result in a reasonable prognosis.

Folded intraluminal drain tube stent in esophageal reconstruction with free jejunal flaps

Conclusions. We believe that this method of nasogastric (NG) tube stenting has the potential to improve the overall result of esophageal reconstruction using free jejunal autografts. Objectives. Microvascular transfer of bowel segments for esophageal reconstruction is indicated in the treatment of esophageal defects. Of the late complications resulting from esophageal reconstruction with jejunal flaps, the most common are stricture and fistula. NG tubes are placed at the time of bowel transfer and inset for gastric decompression and intraluminal stenting. We developed and evaluated a method to decrease these associated risks from NG tube stenting, while at the same time maximizing its use as a neo-esophageal stent in an attempt to prevent stricture formation. Patients and methods. Forty-two patients were evaluated from1999 to 2004 who underwent cervical esophageal reconstruction following esophagectomy with a free jejunal autograft. An NG tube was folded proximally and secured to itself so that the doubled portion of the tube encompassed the reconstructed segment to decrease nasal airway morbidity and increase luminal dilatation and stenting. Timing of tube removal and complications were recorded. Results. The length of follow-up was 24 months. The NG tube was removed in all cases at 2 weeks postoperatively following a normal esophagogram. There were no cases of esophageal perforation or dislodgement. Two patients (4.7%) developed an esophagocutaneous fistula and two patients (4.7%) developed a stricture requiring surgical correction. There were no incidences of sinusitis, alar necrosis, bleeding or mucosal ulceration.

Conservative management for an esophageal perforation in a patient presented with delayed diagnosis: a case report review of the literature

Esophageal perforation is a serious condition with a high mortality rate. Successful therapy depends on the size of the rupture; the time elapsed between rupture and diagnosis, and the underlying health of the patient. Common causes of esophageal perforation include medical instrumentation, foreign-body ingestion, and trauma. A case of esophageal perforation due to fish bone ingestion in a 67-year-old male is described here, with a review of the pertinent literature. The patient presented with chest pain, fever and right-sided pleural effusion. Initial evaluation was nondiagnostic. The water-soluble contrast swallow test showed no evidence of leakage. Computed tomography scan demonstrated a pneumomediastinum, and right-sided hydropneumothorax. The patient was successfully treated using conservative measures.

Surgical and nonsurgical management of perforation complicating endoscopic submucosal dissection of esophageal cancer: report of three cases

Perforation of the esophagus during endoscopic therapy is a severe complicati1on. Nonetheless, almost all perforations made during endoscopic submucosal dissection can be treated conservatively because their early diagnosis, the good condition of the patient, and their small size enables them to be closed with endoscopic clips. If inflammation around the esophagus progresses to mediastinitis, however, surgical management such as debridement and drainage should be applied without delay. Here we report three cases of esophageal perforation during endoscopic submucosal dissection that were successfully treated: in case 1, by drainage of the mediastinal abscess under thoracoscopy; in case 2, by mediastinal drainage from the cervix; and in case 3, by application of endoscopic clips. These techniques are effective and less invasive than other surgical approaches.

Laparoscopic Reconstruction After Esophageal Resection for Perforation

The authors present 2 cases of esophageal perforation treated using a new 2-step approach, consisting of esophageal resection and delayed reconstruction of the digestive tract after laparoscopic preparation and transposition of the stomach. The method is characterized by the minimally invasive insertion of a gastric tube through the precardial esophageal stump for postoperative enteral nutrition, and by the use of a laparoscopic method in the reconstruction step for gastrolysis and transposition of the stomach. The benefits lie in the opportunity for enteral feeding preparatory to the reconstruction, with no need for any gastrostomy or jejunostomy, and with fewer complications and a better recovery after reconstruction surgery thanks to the use of a laparoscopic method instead of a laparotomy.

Stented Esophageal Transfixion Injury

Esophageal perforation is a rare, but life-threatening condition with a mortality rate ranging between 10% and 40%. It can happen at the level of the cervical, intrathoracic, or intra-abdominal segment. It usually occurs as a result of iatrogenic injury after endoscopic procedures or as a spontaneous rupture. It is seen less frequently in trauma after gunshot or stab wounds. Stenting of the esophagus after iatrogenic perforation is well documented in the literature, but yet it is to be published for management of penetrating injury. We report a case of esophageal perforation with a wooden fence post treated successfully with a covered esophageal stent.