Cervical Esophageal Perforation Research Articles

Descending necrotizing mediastinitis caused by a minor whiplash injury.

We describe a case of descending necrotizing mediastinitis (DNM) from a very unusual origin, caused by cervical oesophageal perforation by osteophytes after an apparently minor whiplash injury. Diagnosis was delayed by atypical and predominantly neurological clinical presentation. Despite late presentation, minimally invasive access surgical debridement of mediastinum and cervical injury site lead to full recovery.

S2857 Novel Approaches to Manage Cervical Esophageal Perforation

S2857 Novel Approaches to Manage Cervical Esophageal Perforation

Treatment of delayed cervical oesophageal perforation with T-tube

Cervical oesophageal perforation is a potentially life-threatening situation associated with pooled mortality of 5.9%. Early detection and referral to the thoracic surgery is important. We present a case of an obese lady admitted for foreign body ingestion and had an endoscopic removal of foreign body. Her general condition deteriorated two days later and the diagnosis of delayed cervical oesophageal perforation was made. She was managed surgically by placement of T-tube as controlled-fistula, nasogastric tube insertion and drain at superior mediastinum to control sepsis and contamination. Patient was discharged well despite prolonged hospital stay. T-tube drainage is established as safe and effective to manage delayed cervical oesophageal perforation.

Cervical esophageal perforation with foreign body lodged in the thyroid gland

Cervical esophageal perforation with foreign body lodged in the thyroid gland

Esophageal perforation with double lumen tracheal cannula

We present a case with an unusual complication due to difficult tracheal intubation. A cervical esophageal perforation by a carinal hook in a double lumen cannula after one attempt. Besides the use of antibiotics, his therapeutic option was an endoscopic positioning for seven haemoclips with favorable evolution.

Iatrogenic cervical esophageal perforation: Avoid entering behind a fold in the pyriform sinus

Iatrogenic cervical esophageal perforation: Avoid entering behind a fold in the pyriform sinus

Thoracic esophageal perforation by the use of Magill forceps in infant, success with non-operative treatment: case report

BackgroundEsophageal perforation is a rare surgical pathology in children. Thoracic esophageal perforation is more severe than cervical esophageal perforation. Iatrogenic cause, mainly by endoscopy, is the most common in esophageal perforation. However, perforation induced by “Magill forceps” is exceptional.Case presentationA systematic physical examination revealed pyrexia severe respiratory distress and right-sided pleural effusion.We report the success of non-operative treatment applied to thoracic esophageal perforation due to Magill forceps in a 24-month-old male infant. The immediate and short-term outcomes were excellent.ConclusionsNon-operative treatment is possible in iatrogenic perforation of thoracic esophageal in infants. This treatment delivers excellent outcome in carefully selected patients.

A case of endoscopic extraction of a soft-shelled turtle bone resulted in cervical esophageal perforation

A case of endoscopic extraction of a soft-shelled turtle bone resulted in cervical esophageal perforation

Endoscopic negative pressure therapy (ENPT) in head and neck surgery: first experiences in treatment of postoperative salivary fistulas and cervical esophageal perforations.

Iatrogenic cervical esophageal perforations (CEP) and postoperative salivary fistulas (PSF) are some of the complications requiring treatment in head and neck surgery. Conservative, surgical and endoscopic therapeutic techniques are used. Both CEP and PSF are potentially life-threatening complications and require intensive treatment. Endoscopic negative pressure therapy (ENPT) is an innovative endoscopic surgical procedure for the treatment of transmural intestinal defects throughout the gastrointestinal tract (GIT). In this retrospective study, we demonstrate its application in head and neck surgery. In ENPT, open-pore drains are placed endoscopically in the wound area. The drains can be inserted in an intraluminal position spanning the length of the defect (intraluminal ENPT), or through the defect into the extraluminal wound cavity (intracavitary ENPT). An electronic suction pump applies and maintains a continuous negative pressure of - 125mmHg over a period of several days. The endoscopic drains are changed at regular intervals every few days until stable intracorporeal wound healing by secondary intention or defect closure is achieved. Between 06/2008 and 05/2019 ten patients (f = 3, m = 7; 46-78years old) were treated with ENPT for CEP or PSF. Five patients had postoperative wound defects with consecutive PSF after total laryngectomy or floor of mouth resection. In five patients iatrogenic CEP was found following endoscopic procedures. In all patients treated with ENPT, healing of the perforation defect or fistula was achieved (cure rate 100%). The median treatment duration was 13.7days (range 4-42days). No relevant treatment-associated complications were observed. ENPT is a new, minimally invasive method for treating PSF and CEP.

Oesophageal Perforation Due To Impaction of Dental Foreign Body Material

Oesophageal perforation due to foreign body ingestion mainly seen in children and is rare in adult population. In adults, involuntary ingestion of foreign body usually occurs due to some predisposing factors. Ingestion of dental implant causing esophageal perforation is rare. Our patient is a 50 year old male with history of dental implant ingestion. On attempt of endoscopically removing the implant, impaction of implant occurred leading to perforation of cervical oesophagus. The clinical picture further complicated with formation of pneumomediastiunum, mediastinal collection and subcutaneous emphysema.

A Rare Case of Cervical Esophageal Perforation Caused by a Large Wing-Shaped Fishbone Removed by a Transcervical Approach

A Rare Case of Cervical Esophageal Perforation Caused by a Large Wing-Shaped Fishbone Removed by a Transcervical Approach

Management of deep neck infections from cervical esophageal perforation caused by foreign body: A case series study

PurposeEsophageal perforation caused by foreign body is common in Chinese medical institutions, and resultant deep neck infections (DNI) is quite different from typical DNI. The purpose of this article was to share our experience on management of this particular type of DNI. Material and methodsA retrospective review was conducted on a consecutive sample of such patients at Capital Medical University Beijing Friendship Hospital from 2015 to 2019. ResultsIn total, 24 cases were recorded. CT scan of the neck and upper thorax was the most useful tool for early diagnosis. Gas formation was not predictive of a worse clinical course. Eleven patients with minor DNI were treated with antibiotics and foreign body removal; while 13 patients with major DNI were treated with neck incision and drainage, ICU observation, and prolonged usage of antibiotics. Outcome was generally good, but major complications, including sepsis and lingual artery rupture, could occur. ConclusionsConservative management, focusing on prompt extraction of esophageal foreign body and adequate antibiotic coverage, can lead to good outcome for mild cases; while in addition to these measures, neck incision, cervical and superior mediastinal exploration, and high negative pressure drainage, should be performed for severe cases.

Six-year follow-up of a survivor of cervical spine fracture and dislocation with oesophageal perforation following long scarf syndrome - a case report and literature review

BackgroundAccidental strangulation due to scarf getting caught in the wheels of a vehicle or machine was called “Isadora Duncan Syndrome” or “Long Scarf Syndrome”. Survival of concomitant fracture dislocation of cervical spine and oesophageal perforation following Long Scarf Syndrome was rarely described and medium-term follow-up for this lesion has not been reported.Case presentationWe present a 39-year-old female who suffered accidental strangulation caused by the scarf around her neck getting trapped in the wheels of the a vehicle and was referred to our hospital forty days post injury. The CT examination showed a fracture dislocation at C5/6 levels with complete dissociation of the supporting structures. She developed paravertebral abscesses, cutaneous fistulas and oesophageal perforation confirmed by oesophagoscope. The patient was treated conservatively because of poor general condition and inappropriate initial treatment. Halo-vest was used to immobilize the cervical spine. The oesophagus-cutaneous fistula was managed with enteral tube feeding and repeated local care. The patient survived despite such severe injury. Nine months after the injury, the oesophageal perforation closed spontaneously and fixed malunion of the cervical spine was achieved. Six-year follow-up demonstrated that the patient survived with complete C5 tetraplegia. Literature associated with this lesion was reviewed and factors contributing to the survival were discussed.ConclusionsConcomitant fracture dislocation of cervical spine and oesophageal perforation following Long Scarf Syndrome is extremely rare with high risk of mortality. Though surgical intervention is always necessary, the optimal management for this kind of lesion should be made on an individual basis through a multidisciplinary approach.

Conservative Therapy for Cervical Esophageal Perforation Following Blunt Trauma.

Conservative Therapy for Cervical Esophageal Perforation Following Blunt Trauma.

Contemporary management of traumatic cervical and thoracic esophageal perforation: The results of an Eastern Association for the Surgery of Trauma multi-institutional study.

Traumatic esophageal perforation is rare and associated with significant morbidity and mortality. There is substantial variability in diagnosis and treatment. Esophageal stents have been increasingly used for nontraumatic perforation; however, stenting for traumatic perforation is not yet standard of care. The purpose of this study was to evaluate current management of traumatic esophageal perforation to assess the frequency of and complications associated with esophageal stenting. This was an Eastern Association for the Surgery of Trauma multi-institutional retrospective study from 2011 to 2016 of patients with traumatic cervical or thoracic esophageal injury admitted to one of 11 participating trauma centers. Data were collected and sent to a single institution where it was analyzed. Patient demographics, injury characteristics, initial management, complications, and patient mortality were collected. Primary outcome was mortality; secondary outcomes were initial treatment, esophageal leak, and associated complications. Fifty-one patients were analyzed. Esophageal injuries were cervical in 69% and thoracic in 31%. Most patients were initially managed with operative primary repair (61%), followed by no intervention (19%), esophageal stenting (10%), and wide local drainage (10%). Compared with patients who underwent operative primary repair, patients managed with esophageal stenting had an increased rate of esophageal leak (22.6% vs. 80.0%, p = 0.02). Complication rates were higher in blunt compared with penetrating mechanisms (100% vs. 31.8%, p = 0.03) despite similar Injury Severity Score and neck/chest/abdomen Abbreviated Injury Scale. Overall mortality was 9.8% and did not vary based on location of injury, mechanism of injury, or initial management. Most patients with traumatic esophageal injuries still undergo operative primary repair; this is associated with lower rates of postoperative leaks as compared with esophageal stenting. Patients who have traumatic esophageal injury may be best managed by direct repair and not esophageal stenting, although further study is needed. Therapeutic, level IV.

Cervical esophageal perforation caused by the use of bougie during laparoscopic sleeve gastrectomy: a case report and review of the literature

BackgroundObesity is considered a chronic disease with an increasing prevalence worldwide during the last decades. Laparoscopic sleeve gastrectomy is the most commonly performed bariatric procedure, due to its relative safety and long-term efficacy. The use of bougie to ensure correct size of the gastric tube is part of the standard operation, usually placed by the anesthesiologist and with a very low rate of complications. We report the first case, to our knowledge, of a cervical esophageal perforation caused by the use of bougie during laparoscopic sleeve gastrectomy.Case presentationThe complication occurred in a previously healthy 42-year old female patient who underwent laparoscopic sleeve gastrectomy for class 1 obesity (BMI 31 kg/m2) and was diagnosed the first post-operative day. She was subsequently treated with an emergency thoracoscopy and evacuation of a mediastinal fluid collection, with additional neck incision for primary closure of the esophageal defect which was reinforced with a sternocleidomastoid muscle flap. The post-operative course was uneventful.ConclusionsWe made a literature review to better understand the options considering the diagnosis and treatment in case of very proximal iatrogenic esophageal perforations. The risks related to the use of bougie during surgery should not be underestimated, and its insertion must be done with extreme caution. Esophageal perforation is still a challenging, life threatening complication where prompt diagnosis and adequate treatment are essential.

Repair cervical esophageal perforation after anterior cervical spine surgery using thyroid and thyroid capsule: a case report and literature review

According to the literature review, using thyroid and thyroid capsule to repair cervical esophageal perforation after anterior cervical spine surgery was just mentioned, but no literature reported operative process in detail. In this study, a 51-year-old male patient was admitted to the hospital because of cervical spine injury. The patient underwent anterior cervical discectomy with the iliac bone graft and ORION plate fixation. Esophageal perforation occurred after anterior cervical spine surgery. After conservative treatment, esophageal perforation didn't heal. A repairing operation was performed to remove the plate and repair esophageal perforation using sternocleidomastoid flap. After repairing surgery 6 months, perforation didn't heal completely. A second repairing surgery was performed to repair esophageal perforation using thyroid and its capsule. After second repairing surgery, esophageal perforation healed. The present study reviewed the literature about cause, clinical manifestation, diagnosis method and treatment of esophageal perforation. Using thyroid and thyroid capsule to repair cervical esophageal perforation could offer a treatment option in repairing esophageal perforation, especially the esophageal perforation after muscle flap repair still didn't heal.

2114 Pharyngo-esophageal Perforation During Endoscopic Ultrasound: Case Report and Literature Review

INTRODUCTION: EUS related serious complications such as luminal perforation, pancreatitis and bleeding are rare. We report a case of EUS-related pharyngo-esophageal perforation, successfully managed conservatively and brief literature review. CASE DESCRIPTION/METHODS: A 75-year-old male presented with elevated LFTs without jaundice. CA 19-9 was elevated (112 U/mL). CT revealed a double duct sign and a 3 cm pancreatic head mass (Figure 1). Decision was made to proceed with EUS with FNA. Diagnostic EGD noted no luminal esophageal narrowing. The linear array echoendoscope was inserted into the oropharynx but was difficult to pass into the esophagus secondary to cervical osteophytes. The gastroscope was reinserted into the esophagus. Minimal pharyngeal mucosal trauma was noted. A savary guidewire was passed into the stomach; the gastroscope was removed. The echoendoscope was backloaded onto the wire and reinsertion attempted. Despite gentle maneuvers and multiple attempts, resistance to passage was encountered, esophageal intubation was not possible; the echoendoscope was removed. Repeat EGD revealed a 2 cm deep mucosal tear extending from the posterior pharynx to the esophageal inlet without full-thickness perforation or significant bleeding (Figure 2). The gastroscope and the guidewire were removed and the procedure was terminated. Patient complained of throat pain, especially with swallows. CT showed pneumomediastinum and extraluminal air and edema adjacent to the right aspect of the pharynx & esophagus (Figure 3), consistent with a pharyngo-esophageal microperforation. Thoracic surgery was consulted, antibiotics started, patient kept NPO. The patient remained hemodynamically stable with improved pain and no need for surgical intervention, discharged home on post-procedure day 4. DISCUSSION: EUS is a safe procedure with complication rates comparable to EGD. The rate of esophageal perforation is very low, ranging from 0.03-0.04%. The treatment for pharyngo-esophageal perforation depends upon the degree, location, timing of diagnosis, hemodynamic status and clinical status of the patient. In a case series of 16 cervical esophageal perforations, 44% of patients had history of difficult intubation with endoscopic procedures. 81% were managed conservatively.1 Early recognition and timely management is critical for ensuring an excellent outcome with conservative management. JOURNAL/ajgast/04.03/00000434-201910001-02115/figure1/v/2023-08-15T171636Z/r/image-tiff JOURNAL/ajgast/04.03/00000434-201910001-02115/figure2/v/2023-08-15T171636Z/r/image-tiff JOURNAL/ajgast/04.03/00000434-201910001-02115/figure3/v/2023-08-15T171636Z/r/image-tiff

An Innovative Technique to Repair Cervical Oesophageal Perforation using Oro-oesophageal Tube and AMBU

Introduction
 Oesophageal perforation is a rare condition and has high morbidity and mortality. Both the morbidity and mortality are directly related to the delay in diagnosis and start of treatment. Primary closure with drainage is recommended if perforation is detected in less than 24 hours. Treatment for delayed or missed rupture of oesophagus is not very clear and is controversial.
 Case Report
 We hereby report a case of delayed diagnosed cervical oesophagus rupture following gunshot, which was primarily repaired. Special emphasis is on newer technique of fistula localization using oro-oesophageal tube and AMBU for better closure. The fistula closure was successful and no there were no post-operative complications.
 Discussion
 The symptoms and signs on presentation of patient of cervical oesophagus perforation are discussed along with the differing treatment paradigms for early versus late presentation. Surgical repair with primary closure may be undertaken, even in late presentation of oesophagus rupture. This technique of oro-oesophageal tube used along with AMBU, may be useful in cases of both cervical and upper thoracic oesophagus rupture.

Analysis in diagnosis and treatment of 29 cases of cervical esophageal perforation

Objective: To analyze and summarize the method and effect of cervical esophagus perforation. Methods: A total of 29 cervical esophageal perforation patients caused by foreign body were retrospectively analyzed from January 2012 to June 2018 in Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Nanchang University. Results: Among the 29 cervical esophageal perforation patients, 28 patients were extracted by lateral neck incision, 1 patient with carotid artery hemorrhea was rescued by repairing the fistula between carotid artery and esophage. All patients recovered and successfully discharged. There were no severe complications among all patients. Conclusions: The cervical CT scan is important for diagnosing a cervical esophageal perforation. Enhancement CT scan is necessay for a patient with haematemesis. Lateral neck incision would be first choice for patients with big foreign bodies. Inflammatory reaction and finger palpation are helpful for locating foreign bodies.