Case Of Esophageal Perforation Research Articles

Oesophageal perforation following ingestion of over-the-counter ibuprofen capsules

We present a rare case of oesophageal perforation following ingestion of over-the-counter ibuprofen capsules. Case report and literature review of pill oesophagitis. A previously well, 18-year-old man presented with sudden onset, severe, retrosternal pain, dysphagia and odynophagia following ingestion of over-the-counter ibuprofen capsules. Plain X-ray films and a contrast-enhanced computed tomography scan indicated the diagnosis. The patient was successfully treated with non-operative management. To our knowledge, this is the first report in the world literature concerning oesophageal perforation with ibuprofen. We discuss pill-induced oesophageal injury and its prevention. Manufacturers, clinicians and patients can all take steps to avoid this potentially life-threatening complication.

Stent-Induced Esophageal Perforation: Treatment by Means of Placing a Second Stent After Removal of the Original Stent

A case of esophageal perforation caused by a retrievable covered stent is presented. The distal end of the stent was protruding into the mediastinum, which made it impossible to negotiate a guidewire through the stent into the distal esophagus. The stent was successfully removed with use of a stent retrieval set, and esophageal perforation was treated with a second, covered stent with a good result. Fatality associated with this complication might be prevented by virtue of the retrievability of the stent we used. This result points to the effectiveness of a retrievable stent for the palliative treatment of malignant esophageal stricture.

Oesophageal Perforation after Anterior Cervical Spine Fixation: An Unusual Combination of Predisposing Factors.

A case of oesophageal perforation is being reported following anterior cervical plating in burst facture of C5 vertebra (Frankel Grade A) at 2 weeks following surgery. The multiple etiological factors responsible possibly are proud implant, subtle surgical insult during surgery and an unusual predisposing factor of early intake of solid diet postoperatively, i.e. second postoperative day. No similar report addressing to the issue was found. The diagnosis was confirmed by gastrograffin swallow and oesophagoscopic study. The adequate trial of conservative treatment was given, failing which reexploration, removal of implant, repair of oesophagus and sternocleidomastoidoplasty with feeding jejunostomy was carried out. Patient responded well to treatment and started tolerating solid diet. The patient died 195 days after admission due to a massive intestinal bleed which could probably be drug induced. Keywords: Esophageal perforation; Cervical spine; TraumaNigerian Journal of Orthopaedics and Trauma Vol. 6 (2) 2007: pp. 91-93

Management of Hypopharyngeal and Esophageal Perforations in Children: Three Case Reports and a Review of the Literature

We report 2 cases of pediatric hypopharyngeal perforation that occurred during endoscopy and 1 case of esophageal perforation that developed during nasogastric tube insertion at a tertiary care academic medical center. These cases were identified during a retrospective chart review. All 3 patients were treated with intravenous antibiotics and nasogastric tube feedings, and none experienced further sequelae. Perforations of the hypopharynx and esophagus in children during endoscopy or insertion of endotracheal and nasogastric tubes are not uncommon. Many affected children can be managed conservatively without surgical drainage, depending on the cause and specific location of the perforation and the timing of the diagnosis. We discuss the clinical criteria for various management options, and we offer an algorithm that outlines important clinical considerations in the decision-making process. Our aim in presenting these cases is to increase awa reness of the management options for children with hypopharyngeal and esophageal perforations and to demonstrate the effectiveness of nonsurgical management in selected cases.

An Iatrogenic esophageal perforation with dentures: How Does It Happen?

We present a rare case of esophageal perforation in an attempt of removing an ingested denture with a flexible esophagoscope by a general practitioner. The Computerized Tomography (CT) scan of neck and thorax confirmed the diagnosis and denture was successfully removed through rigid esophagoscopy and perforation was surgically repaired by thoracotomy approach. The presentation of this case could be a revelation for the general practitioners. The various aspects of denture as an esophageal foreign body and the esophageal perforation have been discussed.

Perforation iatrogène de l'œsophage suite à une intubation trachéale difficile imprévisible

The authors report a case of oesophageal perforation after difficult tracheal intubation. Interest of an early diagnosis and management of such complication are discussed.

Esophageal Stents for Iatrogenic Esophageal Perforations During Cardiac Surgery

The usefulness and safety of transesophageal echocardiography during cardiac surgery have been well described in the literature. However, rare complications of this procedure can occur and should be familiar to surgeons and anesthesiologists. A series of two cases of esophageal perforation by echoprobe during cardiac surgery treated successfully by endoscopic stenting are reported.

Successful endoscopic hemoclipping of an esophageal perforation

We describe a case of esophageal perforation that resulted from a fishbone. A 71-year-old man had had a fishbone impacted in the lower esophagus for 2 days. At presentation, the bone was dislodged at endoscopy; one round opening in a deep ulceration was detected when the fishbone was removed. The perforation was closed by endoscopic hemoclipping, after the removal of the fishbone. A thoracic computed tomography revealed air around the esophagus, aorta and bronchus and the presence of a pleural effusion. These findings suggested mediastinal emphysema and mediastinitis due to the esophageal perforation after the removal of the fishbone. Esophagography revealed a focal esophageal defect and linear contrast leakage at the distal esophagus. The mediastinal emphysema and pleural effusion successfully resolved after the endoscopic hemoclip application and conservative management of the perforation.

Sindrome De Boerhaave: Presentacion De Un Caso

Objective. Description of a case of esophageal perforation handled in the Hospital Juarez de Mexico. Description of the case. Masculine patient of 54 years of age, with importance antecedents of being chronic alcoholic and smoker. It presents pain in epigastric, accompanied by nauseous and vomits and later respiratory difficulty. To the clinic exploration is added only identifies an increase of volume of soft parts in both regions supraclavicular. Conclusions. The spontaneous rupture of the esophagus represents 15% and is known like Boerhaave syndrome, described for the first time in 1724 by Dutch doctor Herman Boerhaave (1668-1738). It takes place in patients with intense vomits and that often have ingested great amounts of alcohol. The cause of the injury is the abrupt increase of the pressure intra-esophageal, with passage of the gastric content towards the mediastinum causing serious mediastinitis, sepsis and shock.

Validation of a New Endoscopic Technique to Assess Acid Output in Zollinger–Ellison Syndrome

To safely manage the hypersecretory state in patients with Zollinger-Ellison syndrome, both upper endoscopy and gastric analysis are required to titrate optimal medical therapy. Conventional gastric analysis requires more than 1 hour to perform and results in significant patient dissatisfaction. In this study, we have validated endoscopic gastric analysis as a novel technique that can effectively replace conventional gastric analysis. In a prospective, cross-over study, 12 patients with Zollinger-Ellison syndrome underwent gastric analysis, first by the conventional method and then by an endoscopic technique performed on the same day. Acid concentration was determined by titration, volume output was recorded, and acid output was calculated using standard methodologies and formulas. Agreement was assessed following the Bland-Altman method. To assess repeatability, both techniques were repeated on the same day in a subset of patients. Excellent agreement was reported between acid output (95% limits of agreement, -1.27 to 1.61 mEq/h) and acid concentration (95% limits of agreement, -0.01 to 0.01 mEq/mL), although poor agreement was observed between volume output measured. Endoscopic gastric analysis showed greater reproducibility regarding acid and volume output measured. We introduce a new, rapid, reproducible, and accurate endoscopic technique to measure acid output in patients with Zollinger-Ellison syndrome who require both annual endoscopy and gastric analysis. The data presented here suggest that endoscopic gastric analysis would be equally effective in determining acid output in other hypersecretory states. Additional analysis of cost effectiveness is needed to evaluate its use as a screening tool in select populations.

Successful Management of Esophageal Perforation Diagnosed 3 Days After Injury Caused by an Explosion in the Workplace: Report of a Case

We report a case of esophageal perforation caused by an explosion, but which was not diagnosed until 3 days after the injury. A 53-year-old worker sustained superficial dermal burns to his trachea, face, neck, and legs during an explosion. The burns were treated conservatively at a local hospital, but he was transferred to our hospital 3 days after the injury, when mediastinal emphysema and bilateral pleural effusion became evident. An esophagogram followed by computed tomography showed an esophageal perforation caused by the blast injury, and we performed an esophagectomy with recontruction of the gastric tube. After the operation, an X-ray showed a foreign body in the lower abdomen, which we found in the upper thoracic esophagus on the day of injury. We surmised that the patient had inadvertently swallowed a foreign body, which had been heated and scattered by the explosion, and it had melted the upper thoracic esophagus.

Endoscopic dilatation of esophageal strictures in children and adolescents

To assess the causes of esophageal stricture in pediatric patients and their response to endoscopic dilatation. Retrospective analysis of clinical and endoscopic data obtained from children and adolescents with esophageal stricture submitted to endoscopic dilatation between July 1993 and January 2003. A total of 125 patients aged between 1 month and 16 years were included in the study. Among the types of stenosis, postoperative (43.2%), corrosive (27.2%) and peptic (21.6%) strictures were the most prevalent. Those patients with corrosive esophageal stricture needed more dilatation sessions. Five cases of esophageal perforation and one case of hemorrhage occurred due to complications during the procedure. Good response to endoscopic treatment was described in 74.4% of cases, but better results were obtained from patients with peptic esophageal stricture. Endoscopic treatment of esophageal strictures in children and adolescents yields good results and has a low rate of complications. Corrosive esophageal strictures have a higher morbidity and require more dilatation sessions.

Esophageal Perforation: Principles of Diagnosis and Surgical Management

Esophageal perforation (EP) is still associated with a high mortality rate, even after surgical repair. We reviewed 17 cases of EP to evaluate the management of this major surgical problem. We reviewed the medical records of all patients treated for EP in our department between November 2001 and November 2004. Therapy was based on various patient-related factors. Seventeen patients, with a mean age of 63 years, presented with EP mostly caused by iatrogenic incidents (11/17). In nine patients, the perforation was located in the thoracic segment, with a mean size of 2.5 +/- 0.6 cm. Thoracic computed tomography (CT) was performed in all patients to assess the periesophageal inflammation precisely. More than 50% showed signs of systemic inflammation indicative of sepsis, reflected by a dramatic increase in serum C-reactive protein and leukocytosis. Treatment consisted of debridement and drainage (n = 3), primary repair (n = 3), reinforced repair (n = 4), esophageal resection (n = 5), and conservative measures (n = 2). All patients, except for three with pre-existing liver dysfunction and other comorbidities, survived, representing a mortality rate of 17.6% (14/17). An analysis of the literature (2000-2005) revealed an overall mortality rate of 19.7% (101/521), ranging from 3% to 67%. Our data support the individualized surgical management of EP, based on careful evaluation of various patient-related factors, including CT findings.

Oesophageal perforation. A report of 13 cases.

Abstract A series of 13 cases of oesophageal perforation seen between 1961 and 1972 is reported. The various causes of perforation are discussed, with emphasis on the need for rapid diagnosis. Conservative treatment is considered to lead to a high mortality-rate. One of the 10 patients who were treated surgically in this series died. It is recommended that patients with a carcinoma be treated in a single operation, and in achalasia of the cardia the use of a rigid oesophagoscope should be avoided.

Oesophageal perforation during abdominal truncal vagotomy for duodenal ulcer.

Abstract A retrospective survey of patients having truncal vagotomy for duodenal ulceration has been carried out. In this series 41 cases of oesophageal perforation occurred; 29 were recognized at the time of operation, 6 were diagnosed postoperatively, and in the remaining 6 the time of diagnosis was not specified. Two of the 29 patients in whom the oesophageal perforation was recognized at the time of operation died, as did 2 of the 6 cases diagnosed postoperatively. An increase of mortality and morbidity occurred in those diagnosed postoperatively. The importance of confirming oesophageal integrity at the conclusion of vagotomy is stressed.

Esophageal Perforation after Placement of Wireless Bravo pH Probe

Purpose: Esophageal pH monitoring is important in patients with atypical or refractory gastroesophageal reflux disease (GERD). The technology of esophageal acid exposure monitoring with the use of a catheter-free radiotelemetric pH capsule, called the BRAVO™ pH monitoring system (Medtronic Inc., Shoreview, MN) is a recent new technique demonstrated to be comparable to the conventional catheter system for quantifying esophageal pH. Its use is more comfortable and allows the patient to be more active during the test period with minimal complications. We describe a case of esophageal perforation during that occurred during the placement of the catheter delivery system. A 67/F with recurrent reflux underwent EGD and placement of a BRAVO™ pH probe. EGD was normal. During advancement of the BRAVO™ catheter probe, resistance was met at the proximal esophagus. Immediate withdrawal of the catheter and endoscopy revealed a large mucosal tear and the procedure was immediately aborted. After the procedure, the patient had chest discomfort, was afebrile and hemodynamically stable. Cardiac, pulmonary and abdominal examinations were normal. CBC and electrolytes are all normal other than mild leukocytosis (WBC 13.6) which normalized the next day. Pharyngoesophagram with gastrograffin contrast demonstrated extraluminal extravasation of gastrograffin in the upper esophagus along the anterior left aspect. The CT scan of the chest demonstrated air in the posterior mediastinum consistent with esophageal perforation. The patient was admitted for observation and managed conservatively, i.e. NPO, pain control, IV hydration, and coverage with broad spectrum antibiotics. The patient remained stable over the next few days, and a clear liquid diet was started on the 4th hospital day was eventually discharged on the 6th hospital day without developing further complications, with the advice of advancing to a regular diet after within one week, and to continue a one-week course of oral antibiotics. After several weeks after the incident, the patient was eventually able to resume her normal diet and activities without developing further complications. The BRAVO™ pH system is well tolerated and its use in several institutions is becoming more widespread. Recognition that esophageal perforation may be a complication is important. The physician should consider such risks in the consideration of determining the appropriateness of testing in patients with GERD.

Esophageal Perforation due to an Impaction of Omitted Dental Prosthesis after General Anesthesia: A case report

Foreign body ingestion induces various complications during the induction of and emergence from anesthesia. These complications include inconsequential mucosal scratches, abrasion, laceration, esophageal stricture, necrosis, retropharyngeal abscess formation, hemorrhage, obstruction and perforation. We experienced a case of esophageal perforation after ingestion of a dental prosthesis during emergence. A 71-year-old female patient received general anesthesia for a lumbar laminectomy. At postanesthesia care unit, she complained of a sore throat and found that her dental prosthesis was missing. The impacted dental prosthesis was found at the T7 level, which was followed due to its perforation through the esophageal wall, causing mediastinitis. She underwent an operation for the esophageal repair and was discharged with slight chest discomfort due to operation, after 10 days.

Alarming Pneumomediastinum but Benign Outcome: a Case Report on Oesophageal Perforation by Foreign Body

A case of oesophageal perforation after endoscopic removal of foreign body is described. A 50‐year‐old female had a sharp fish bone impacted in the cervical oesophagus. After dislodging the bone at endoscopy, she developed neck pain and swelling. Chest X‐ray showed alarming pneumomediastinum and subcutaneous emphysema. However, there was no leakage in the water‐soluble contrast swallow. She was successfully managed conservatively. Early recognition and proper management of such a well‐known complication are important to lower morbidity, especially in view of the fact that endoscopic removal of swallowed foreign bodies is being performed on an outpatient basis in some emergency departments. Special precaution should be given to sharp foreign bodies lodged at the cervical oesophagus.

Oesophageal perforation in preterm neonates: not an innocent bystander.

To compare the clinical course and neonatal outcomes of preterm infants with oesophageal perforation (OP). Retrospective case control study of infants admitted between 1994 and 2001 and diagnosed with OP was performed at two tertiary care centres in Toronto, Canada. One control per case was matched by the gestational age and the month of birth. Occurrence of air leak syndrome/pleural effusion requiring drainage, the duration of supplemental oxygen and the time to attain full feeds were compared. Ten cases of OP were identified. The commonest clinical presentation was air leak syndrome/pleural effusion. There was a statistically significant increase in the time to attain full enteral feeds in OP group (P = 0.02). The duration of supplemental oxygen was prolonged in infants with OP, however, this was statistically insignificant (P = 0.20). The infants were managed conservatively and perforation healed in all. Oesophageal perforation is a rare but important complication of modern neonatal intensive care setting. The diagnosis of OP should be considered in infants who present with sudden/acute deterioration in their respiratory status following procedures involving pharyngeal region. Conservative management in an otherwise uncomplicated case leads to complete recovery in neonates.

Esophageal perforation by echoprobe during cardiac surgery: treatment by endoscopic stenting

The usefulness and safety of transesophageal echocardiography during cardiac surgery have been well described in the literature. However, rare complications of this procedure can occur and should be familiar to surgeons and anesthesiologists. A case of esophageal perforation by echoprobe during coronary artery bypass grafting treated successfully by endoscopic stenting is reported.