Non-traumatic esophageal perforation: A case report on Boerhaave’s syndrome

Boerhaave’s syndrome is a potentially fatal condition characterized by spontaneous perforation of a previously healthy esophagus, due to severe vomiting or straining. It often presents with non-specific symptoms such as fever, pain, and vomiting and hence may go undiagnosed. The Makler’s triad, consisting of vomiting, chest pain, and subcutaneous emphysema, may be seen in only 50% of cases. Delayed diagnosis may result in complications such as sepsis, mediastinitis, pneumothorax, and multi-organ dysfunction. In general, patients presenting later than 48 h are conservatively managed with esophageal stenting. Surgical repair is usually reserved for those patients who present within 24 h, or are managed conservatively and develop complications. Mortality rises from 0% if treated within 24 h to about 29% if delayed more than 48 h. We present a case of Boerhaave’s syndrome in a 35-year-old male who presented with spontaneous respiratory distress and hemodynamic instability, about 36 h after the onset of vigorous vomiting. The case was managed initially with endoscopic insertion of a self-expanding metallic stent, followed later by surgical closure of the esophageal perforation. The patient, however, developed post-operative septic complications and died after a week

FLEXIBLE VERSUS RIGID ESOPHAGOSCOPY IN THE MANAGEMENT OF ESOPHAGEAL FOREIGN BODY IMPACTION

Background: Foreign body(FB) impaction accounts for 4% of emergency endoscopies in clinical practice. Flexible endoscopy(FE) is a recommended therapeutic option because it can be performed under local anesthesia, it is cost effective and is well tolerated. Rigid endoscopy (RG) under general anesthesia is another option and is advantageous in some circumstances. The aim of the study is to compare ef?cacy and safety of ?exible and rigid esophagoscopy in esophageal foreign body removal. It is a prospective study done in E.N.T department in KIMS Methods: MEDICAL COLLEGE, Amalapuram, which includes 50 patients with impacted foreign body esophagus. Parameters like type of foreign body, location of impacted foreign body are included. The study analyzies the type of procedure the patient have undergone, the intra operative and post operative complications. This prospective cohort study includes 50 patients Results: who have undergone surgical procedure for removal of impacted foreign body. Flexible esophagoscopy is performed in 30 patients and rigid esophagoscopy is performed in 20 patients . The most frequent complications are mucosal erosion, mucosal edema, and ulceration. Flexible esophagoscopy and rigid esophagoscopy are equally safe and effective for Conclusion: removal of impacted esophageal foreign body

Barogenic perforation of the esophagus: An unusual manifestation / Perforación barogénica del esófago: una presentación inusual

Abstract Introduction: Typically, when esophageal perforation secondary to barotrauma is mentioned as the causal pathophysiological mechanism of perforation, the literature refers to spontaneous esophageal perforation or Boerhaave syndrome as an entity. It involves the longitudinal and transmural rupture of the esophagus (previously healthy) secondary to an abrupt increase in intraluminal esophageal pressure, frequently triggered during vomiting. However, in the medical literature, some reports list mechanisms of barotrauma other than this entity. Case report: A 64-year-old female patient with a history of surgically managed gastric adenocarcinoma (total gastrectomy and esophagoenteral anastomosis) presented with stenosis of the esophagojejunal anastomosis, which required an endoscopic dilatation protocol with a CRETM balloon. The third session of endoscopic dilation was held; in removing the endoscope, we identified a deep esophageal laceration with a 4 cm long perforation at the level of the middle esophagus (8 cm proximal to the dilated anastomosis), suspecting the mechanism of barotrauma as the causal agent. She required urgent transfer to the operating room, where we performed thoracoscopic esophagectomy, broad-spectrum empiric antimicrobial coverage, and enteral nutrition by advanced tube during in-hospital surveillance. The control esophagram at seven days showed a small leak over the anastomotic area, which was managed conservatively. Imaging control at 14 days showed a decrease in the size of the leak, with good evolution and tolerance to the oral route. The patient was later discharged.

Resumen Introducción: típicamente, cuando se menciona la perforación esofágica secundaria a barotrauma como el mecanismo fisiopatológico causal de la perforación, la literatura se refiere a la perforación esofágica espontánea o síndrome de Boerhaave como entidad, la cual hace referencia a la ruptura longitudinal y transmural del esófago (previamente sano) secundaria a un aumento abrupto de la presión intraluminal esofágica, que se desencadena frecuentemente durante el vómito. Sin embargo, en la literatura médica existen algunos reportes que mencionan otros mecanismos de barotrauma diferentes a esta entidad. Reporte de caso: se presenta el caso de una paciente de 64 años con antecedente de adenocarcinoma gástrico manejado quirúrgicamente (gastrectomía total y anastomosis esofagoenteral), quien presentaba estenosis de anastomosis esofagoyeyunal, que requirió un protocolo de dilatación endoscópica con balón CRETM. Se llevó a una tercera sesión de dilatación endoscópica, en la que durante la extracción del endoscopio se identificó una laceración esofágica profunda con perforación de 4 cm de longitud a nivel del esófago medio (8 cm proximal a anastomosis dilatada), y se sospechó del mecanismo de barotrauma como agente causal. Requirió traslado urgente a sala de cirugía, en la que se realizó esofagorrafia por toracoscopia, cubrimiento antimicrobiano empírico de amplio espectro y nutrición enteral por sonda avanzada durante la vigilancia intrahospitalaria. El esofagograma de control a los 7 días mostró una pequeña fuga sobre el área anastomótica, la cual se manejó de manera conservadora. El control imagenológico a los 14 días evidenció una disminución del tamaño de la fuga, con una evolución satisfactoria y tolerancia a la vía oral, y posteriormente se dio el egreso.

Síndrome de Boerhaave: manejo diagnóstico y terapéutico en el Hospital Regional de Talca / Boerhaave Syndrome: diagnostic and therapeutic management at the Hospital Regional de Talca

Introduction: Boerhaave syndrome is a spontaneous rupture of the esophageal wall caused by a sudden increase in intraesophageal pressure. It represents an incidence of approximately 15% of all esophageal perforations, which do not exceed 3.1 per 1 million inhabitants per year. Objectives: To communicate the clinical presentation and management of patients with this syndrome, as well as to reveal the different options available in our service for its treatment. Methods: Search in the statistical data of the regional Hospital of Talca for patients with a diagnosis of Boerhaave syndrome. Five patients were found. Information was obtained from their clinical records and is presented as a clinical case report with a descriptive analysis of their management. Results: Of the 5 clinical cases presented, a classic clinical presentation can be observed, most of the patients presented with vomiting that later evolved with thoracic and/or epigastric pain, associated with imaging studies suggesting esophageal perforation. Management was surgical in 100% of the cases, applying different techniques described in the literature. Discussion and Conclusion: Boerhaave syndrome is a medical-surgical emergency that requires timely management. In spite of the variety of management and the consequences of each one of them, all the patients had an evolution that allowed them to preserve their lives until nowadays. Keeping a high index of suspicion and choosing the best management will have an impact on morbidity and mortality.

Neumomediastino en trauma contuso: ¿son siempre necesarios los estudios invasivos para descartar lesión aerodigestiva? / Pneumomediastinum in blunt trauma: Are invasive studies always necessary to rule out aerodigestive injury?

Introducción. La presencia de neumomediastino secundario a un trauma contuso es un hallazgo común, especialmente con el uso rutinario de la tomografía computarizada. Aunque en la mayoría de los casos es secundario a una causa benigna, la posibilidad de una lesión aerodigestiva subyacente ha llevado a que se recomiende el uso rutinario de estudios endoscópicos para descartarla. El propósito de este estudio fue determinar la incidencia de neumomediastino secundario a trauma contuso y de lesiones aerodigestivas asociadas y establecer la utilidad de la tomografía computarizada multidetector en el diagnóstico de las lesiones aerodigestivas. Métodos. Mediante tomografía computarizada multidetector se identificaron los pacientes con diagnóstico de neumomediastino secundario a un trauma contuso en un periodo de 4 años en un Centro de Trauma Nivel I. Resultados. Fueron incluidos en el estudio 41 pacientes con diagnóstico de neumomediastino secundario a un trauma contuso. Se documentaron en total tres lesiones aerodigestivas, dos lesiones traqueales y una esofágica. Dos de estas fueron sospechadas en tomografía computarizada multidetector y confirmadas mediante fibrobroncoscopia y endoscopia digestiva superior, respectivamente, y otra fue diagnosticada en cirugía. Conclusión. El uso rutinario de estudios endoscópicos en los pacientes con neumomediastino secundario a trauma contuso no está indicado cuando los hallazgos clínicos y tomográficos son poco sugestivos de lesión aerodigestiva.

Introduction.The presence of pneumomediastinum secondary to blunt trauma is a common finding, especially with the use of computed tomography. Although in most cases the presence of pneumomediastinum is secondary to a benign etiology, the possibility of an underlying aerodigestive injuries has led to the recommendation of the routine use of endoscopic studies to rule them out. The purpose of this study was to determine the incidence of pneumomediastinum secondary to blunt trauma and associated injuries and to establish the role of multidetector computed tomography in the diagnosis of aerodigestive injuries. Methods.Using multidetector computed tomography, patients with a diagnosis of pneumomediastinum secondary to blunt trauma were identified over a period of 4 years in a Level 1 Trauma Center. Results. Forty-one patients diagnosed with pneumomediastinum secondary to blunt trauma, were included in this study. Two airway ruptures were documented: two tracheal injuries and one esophageal injury. Two of them suspected on multidetector computed tomography and confirmed on bronchoscopy and esophagogastroduodenoscopy, respectively, and another was diagnosed in surgery. Conclusion.The routine use of endoscopic studies in patients with pneumomediastinum secondary to blunt trauma is not indicated when the clinical and tomographic findings are not suggestive of aerodigestive injury.

Lesão transfixante de carótida por espinha de peixe - relato de caso / Carotid artery perforation by fish bone - a case report

Abstract Accidental fish bone ingestion is a common complaint at emergency departments. The majority of cases have a benign course. However, serious complications such as esophagus perforation, cervical vessel injury and cervical abscess can occur in 7.4% of cases. Mortality rates can be as high as 50% when mediastinitis occurs. We report a case of an esophageal perforation caused by a fish bone with a lesion to the right common carotid artery after 20 days of evolution. Surgical exploration occurred with corrections of the lesion in the right common carotid and esophagus. Early identification of this kind of injury is paramount to prevent potentially fatal complications.

Abstract Accidental fish bone ingestion is a common complaint at emergency departments. The majority of cases have a benign course. However, serious complications such as esophagus perforation, cervical vessel injury and cervical abscess can occur in 7.4% of cases. Mortality rates can be as high as 50% when mediastinitis occurs. We report a case of an esophageal perforation caused by a fish bone with a lesion to the right common carotid artery after 20 days of evolution. Surgical exploration occurred with corrections of the lesion in the right common carotid and esophagus. Early identification of this kind of injury is paramount to prevent potentially fatal complications.

The experience of surgical methods without repairing the fistula for 92 cases with gastrointestinal intrathoracic fistula / 中华胸心血管外科杂志

Objective:To summarize the experience of surgical methods without repairing the fistula for 92 cases with gastrointestinal intrathoracic fistula.Methods:The surgical methods without repairing the fistula were performed through VATS, small incision assisted with VATS or thoracotomy. The focus of the surgery was to promote lung expansion, eliminate the residual cavity of chest cavity and keep effective drainage. After entering the chest cavity from the affected side, wash chest cavity with a large amount of warm normal saline and sterilize intermittently with iodophor to ensure the sterile environment in the pus cavity. Then completely remove the pleural cellulose or fiberboard on visceral pleura to promote lung expansion, eliminate the residual cavity of the chest cavity. The fistula was covered tightly and supported firmly by the visceral pleura on the lung. Multiple T-tubes were placed in thoracic cavity and fistula to keep effective postoperative drainage.Results:Among 92 cases, 85 cases were cured and the cure rate was 92.4% (85/92).7 cases died and the mortality rate was 7.61% (7/92). The 7 dead cases include 5 cases with esophagogastric anastomotic fistula (the death of 3 cases was cause by aortic esophagogastric fistula, the death of 1 case was cause by thoracic gastric tracheal fistula and 1 case was dead because of pulmonary infection and respiratory failure), 1 case with esophageal rupture (the cause of death was septic shock ), and 1 case with esophageal perforation(the cause of death was pulmonary infection and respiratory failure).Conclusion:Most of the surgeries without repairing gastrointestinal intrathoracic fistula are conducted simply through VATS or small incision assisted with VATS., which is safe and effective.

Colgajo muscular de esternocleidomastoídeo para el manejo de perforación esofágica tardía: reporte de dos casos / Muscle flap of sternocleidomastoid for the management of late esophageal perforation: report of two cases

Resumen Introducción: La perforación esofágica es una complicación poco frecuente en la cirugía de columna cervical por vía anterior, sin embargo, puede tener graves consecuencias cuando hay demoras en diagnóstico y tratamiento. Casos Clínicos: Presentamos dos casos clínicos de pacientes con perforación esofágica secundaria a cirugía de columna cervical por vía anterior. Se usaron para su reparación colgajo muscular de esternocleidomastoideo (ECM). Conclusión: La perforación esofágica secundaria a cirugía de columna cervical es poco frecuente, variable desde el punto de vista clínico, el TC y estudio radiológico contrastado son fundamentales en el diagnóstico de esta patología. El colgajo muscular ECM en estos casos es una herramienta fiable y extremadamente útil debido a sus características anatómicas, fácil disección quirúrgica y baja morbilidad asociada.

Introduction: Esophageal perforation is a rare complication in cervical spine surgery by anterior way, however it can have serious consequences when there are delays in diagnosis and treatment. Cases Report: We present two clinical cases of patients with esophageal perforation secondary to cervical spine surgery by anterior way. Sternocleido-mastoid muscle flaps were used for repair. Conclusion: Esophageal perforation secondary to cervical spine surgery is rare, clinically variable, CT and radiologic study are fundamental in the diagnosis of this pathology. The Sternocleidomastoid muscle flap in these cases is a reliable and extremely useful tool due to its anatomical characteristics, easy surgical dissection and low associated morbidity.

Síndrome de Boerhaave como complicación del consumo de alcohol: reporte de caso / Boerhaave syndrome as a complication of alcohol consumption: case report / Síndrome de Boerhaave como complicação do consumo de álcool: relato de caso

Los diferentes reportes de consumo de sustancias evidencian cómo el consumo de alcohol afecta diferentes órganos y sistemas; según el tiempo de presentación hay riesgos agudos y crónicos. Dentro de las complicaciones agudas gastrointestinales asociadas al consumo de alcohol está el síndrome de Boerhaave consistente en una ruptura esofágica espontánea. Es importante identificar este síndrome porque se relaciona con alta mortalidad debido a la amplia gama de signos y síntomas que produce, como vómito, disnea, taquipnea, taquicardia y dolor esternal, que pueden generar confusión con otras enfermedades como el tromboembolismo pulmonar. El objetivo de este reporte es pre-sentar el primer caso clínico en Colombia de un paciente con síndrome de Boerhaave como complicación del consumo de alcohol, ya que es importante que el personal de salud reconozca los factores de riesgo que lo desencadenan.

Numerous reports of substance use show how alcohol consumption affects different organs and systems; related risks can be acute and chronic, depending on the time of presentation. Among the acute gastrointestinal complications associated with alcohol consumption is Boerhaave syndrome, which consists of a spontaneous esophageal rupture. It is important to identify this pathology because it is associated with high mortality due to the wide range of signs and symptoms that it produces such as vomiting, dyspnea, tachypnea, tachycardia, and sternal pain, which can lead to confusion with other diseases like pulmonary thromboembolism and may therefore delay proper and timely diagnostic. The objective of this report is to present the first clinical case reported in Colombia of a patient who suffered from Boerhaave syndrome secondary to chronic alcohol consumption and to sensitize the health personnel about the importance of recognizing alcohol consumption as a risk factor for this complication.

Os diferentes relatos de uso de substâncias mostram como o consumo de álcool afeta diferentes órgãos e sistemas; dependendo da época de apresentação, existem riscos agudos e crônicos. Entre as complicações gastrointestinais agudas associadas ao con-sumo de álcool está a síndrome de Boerhaave, que consiste em uma ruptura esofágica espontânea. É importante identificar essa síndrome, pois está associada a alta mortalidade devido à ampla gama de sinais e sintomas que produz, como vômitos, dispneia, taquipneia, taquicardia e dor esternal, que podem levar à confusão com outras doenças, como tromboembolismo pulmonar. O objetivo deste relatório é apresentar o primeiro caso clínico na Colômbia de um paciente com síndrome de Boerhaave como uma complicação do consumo de álcool, pois é importante que o pessoal de saúde reconheça os fatores de risco que a desencadeiam.

Perforación esofágica espontánea

Resumen La perforación esofágica espontánea es una forma rara de ruptura del grosor de la pared del esófago sano, de manera no traumática. Es característico verla en pacientes de mediana edad, con obesidad y alcohólicos, que tienen episodios violentos de náuseas y vómitos. El tratamiento de la perforación esofágica espontánea depende de varios factores, como la etiología, sitio de la perforación, tiempo transcurrido desde la perforación hasta el diagnóstico, el grado de la contaminación del peritoneo o mediastino, comorbilidades, y estado general del paciente. En este artículo se presenta el caso de un paciente con enfisema subcutáneo en la parte superior del tórax, cuello y cara; con taquicardia de 115 latidos por minuto, hemograma con 18 mil leucocitos con predominio de neutrófilos. Se le realizaron radiografías de tórax y senos paranasales, donde se observa aire entre partes blandas y hueso. Se le realiza tratamiento quirúrgico con cierre de la perforación por toracotomía izquierda, se deja alimentación por sonda nasogástrica y antibióticos por 7 días.

Abstract Spontaneous esophageal perforation is a rare form of non-traumatic rupture of the thickness of the wall of the healthy esophagu. It is observed in middle-aged, obese, and alcoholic patients who have violent episodes of nausea and vomiting. Treatment of spontaneous esophageal perforation depends on several factors, such as the etiology, site of the perforation, time from perforation to diagnosis, degree of contamination of the peritoneum or mediastinum, comorbidities, and general condition of the patient. This article presents the case of a patient with subcutaneous emphysema in the upper part of the chest, neck and face; with a heart rate of 115 beats per minute, with a blood count of 18,000 leukocytes with a predominance of neutrophils. X-rays of the chest and paranasal sinuses were performed, where air is observed between soft tissue and bone. Surgical treatment is performed with closure of the perforation by left thoracotomy, feeding by nasogastric tube and antibiotics is left for 7 days.

Perforación esofágica espontánea: síndrome de Boerhaave. Caso clínico y revisión de la literatura / Boerhaave síndrome: spontaneous esophageal perforation. A clinical case and review of literature / Perfuração esofágica espontânea: síndrome de Boerhaave. Relato de caso e revisão bibliográfica

Resumen: La perforación esofágica espontánea o síndrome de Boerhaave es una entidad poco frecuente. Se define como la rotura del esófago no relacionada con traumatismos, exploraciones invasivas, patología esofágica previa o cuerpos extraños. Las roturas esofágicas se consideran como la perforación más grave del tracto digestivo, con una alta tasa de morbimortalidad relacionada principalmente con el desarrollo de mediastinitis posterior. Presentamos un paciente de sexo masculino de 63 años, que postingesta copiosa presenta esfuerzo de vómito inefectivo y posteriormente intenso dolor epigástrico, acompañado de enfisema subcutáneo. Se realiza tomografía de tórax que evidencia colección de contraste paraesofágica. Con planteo de síndrome de Boerhaave se decide cirugía de urgencia. Destacamos que el principal elemento pronóstico es el tiempo de resolución quirúrgica, por lo que debemos considerar esta patología como diagnóstico diferencial en pacientes con dolor torácico de inicio agudo.

Summary: Spontaneous esophageal perforation or Boerhaave syndrome is rather an unusual condition. It may be defined as the rupture of the esophagus that is not associated to trauma, invasive explorations, previous esophagus pathology or foreign bodies. Esophageal ruptures are considered as the most severe perforations of the digestive tract, with high morbimortality rates which are mainly associated to the development of subsequent mediastinitis. The study presents a 63-year-old patient who, after copious food intake, evidences unsuccessful effort to vomit effort and subsequent intense epigastric pain, accompanied by subcutaneous emphysema. Abdominal contrast scan reveals paraesophageal collection and a decision is made to perform an emergency surgery upon the suspicion of Boerhaave syndrome. It is worth pointing out that time for surgical resolution is the main prognostic element, and thus, this condition is to be considered as differential diagnosis in patients with acute thoracic pain.

Resumo: A perfuração esofágica espontânea ou síndrome de Boerhaave é uma entidade rara. É definida como ruptura do esôfago não relacionada a trauma, exames invasivos, patologia esofágica prévia ou corpos estranhos. As rupturas esofágicas são consideradas as perfurações mais graves do trato digestivo, com alto índice de morbimortalidade principalmente relacionado ao desenvolvimento de mediastinite posterior. Apresentamos um paciente do sexo masculino, 63 anos, que após ingestão abundante apresentou esforço ineficaz de vômito e, posteriormente, dor epigástrica intensa, acompanhada de enfisema subcutâneo. Foi realizada tomografia de tórax que evidenciou coleção de contraste paraesofágico. Com diagnóstico de síndrome de Boerhaave, a cirurgia de emergência foi decidida. Ressaltamos que o principal elemento prognóstico é o tempo de resolução cirúrgica, portanto, devemos considerar essa patologia como um diagnóstico diferencial em pacientes com dor torácica de início agudo.

Enfoque terapéutico en el Síndrome de Boerhaave / Therapeutic Approach of Boerhaave's Syndrome

RESUMEN Introducción: La perforación del esófago constituye una de las urgencias más graves y difíciles que ha de afrontar un cirujano por las características y ubicación del órgano. El pronóstico depende sobre todo de la rapidez del diagnóstico y de la elección del tratamiento instaurado en principio. Objetivo: Presentar un caso portador del Síndrome de Boerhaave. Caso clínico: Paciente masculino en la 5ta década de vida que acudió por dolor torácico posterior a cuadro emético. Luego de estudio radiográfico se diagnosticó ruptura espontánea de esófago o síndrome de Boerhaave. Conclusiones: El enfoque terapéutico adecuado asociado al diagnóstico oportuno y precoz del síndrome garantiza mejores índices de sobrevida(AU)

ABSTRACT Introduction: Esophageal perforation is one of the most serious and difficult emergencies that a surgeon has to face due to the characteristics and location of the organ. Such prognosis depends mainly on the speed of the diagnosis and the choice of treatment established initially. Objectives: To present a case with such syndrome and to review the literature to update the therapeutic approach of this entity given its high mortality. Clinical case: Male patient in the fifth decade of life who presented for chest pain after an emetic condition. After a radiographic study, a spontaneous rupture of the esophagus or Boerhaave syndrome was diagnosed. Conclusions: The appropriate therapeutic approach associated with the early and timely diagnosis of the syndrome guarantees better survival rates(AU)

Screw Migration into Colon after Anterior Cervical Plating - An Unusual Complication: A Case Report

@#Complications in the form of esophageal injury, tracheal injury, injury to carotids, implant failure, loosening of screws, etc do occur after anterior cervical surgeries. Although intra-operative esophageal injuries are as such rare, there have been few reports of delayed esophageal perforation as well after anterior cervical surgeries. We report a very rare case of migration of missing screw from anterior cervical plate after anterior cervical corpectomy and plating, which had ultimately migrated down to colon and had to be removed via colonoscopy. Along with removal of migrated screw from colon, revision of failed anterior cervical surgery was done wherein plate and screws were removed with mesh cage left in-situ as it was snug-fit while pharyngeophageal perforation was explored and was found to be spontaneously healing, with addition of posterior Bohlman’s interspinous wiring for added stability. Migration of screw from the anterior cervical plate into the colon although very rare, should be always kept in mind and its potentially serious complications. We also conclude that particular attention should be given to elderly people with poor bony quality who have high chances of implant failure, along with attention to proper cage size, screw position and proper locking of the screw to further lessen the chances of implant failure.

A Non-surgical Management of Delayed Diagnosis of an Oesophageal Perforation due to Ingestion of Okra: A Case Report

@#Oesophageal perforation is a not uncommon condition, yet it carries a high mortality rate and has been observed as the most grievous trauma to the digestive tract. Common causes include iatrogenic instrumentation, foreign-body swallowing, and physical injury. This report highlighted a case of oesophageal perforation complicated by formation of proximal descending aorta pseudoaneurysm as a result of okra ingestion. The patient was successfully treated with conservative treatment. The possible mechanism of oesophageal rupture, diagnosis, treatment, and other complication will be further discussed.

Diagnosis And Treatment Of Esophagic Trauma In A Reference Hospital.

Background. Penetrating lesions of the esophagus are more common than blunt injuries. The bullet wound (75%) is the main cause of these. In traumatic injuries, primary surgical repair is the standard of treatment. Methods. Observational, Descriptive, cross-sectional, retrospective analysis of patients with esophageal trauma during January 2017 to December 2018. Results.There were 4 male patients, average of hospital stay 37.4 days. The mechanism of injury was: 2 due to injury with a puncturing instrument, 1 due to a gunshot wound (HPAF) and another injury due to perforation with a foreign body. Surgical treatment was: 3 of 4 patients underwent esophageal rafa and one of them had a trachea rafa with a sternocleidomastoid ap. The complications were esophageal stula and tracheal stula. Conclusions.These types of injuries are potentially fatal if there is a delay in diagnosis and treatment.

Manejo de perforación esofágica tardía, secundario a cirugía de columna cervical anterior / Management of a late esophageal perforation secondary to an anterior cervical spine surgery

Resumen Introducción: La cirugía anterior de columna cervical es un procedimiento de rutina para la fijación de fracturas vertebrales inestables, las indicaciones para estabilización de las vértebras son osteomielitis, tumores espinales y trauma. Objetivo: Informar sobre una de las complicaciones poco frecuentes y potencialmente peligrosas de la fijación de columna cervical por vía anterior. Pacientes y métodos: CASO 1: Paciente del sexo masculino de 41 años de edad que sufrió un accidente automovilístico. La tomografía reportó fractura del arco anterior de C1 y fractura de apófisis espinosa de C5-C6. Fue intervenido quirúrgicamente, y se le colocó osteosíntesis con placa. Un mes después presentó perforación esofágica, por lo que fue reintervenido, se le retiró la osteosíntesis, se le realizó un drenaje y se le colocó sistema VAC. Fue dado de alta por evolucionar adecuadamente. CASO 2: Paciente mujer de 53 años de edad, que inició su padecimiento un mes antes, con dolor cervicodorsal. Se le realizó una resonancia magnética en la que se encontró hernia discal C4-C5, C5-C6; se realizó artroplastia con prótesis en C4-C5. Cinco meses después, presentó migración del implante protésico; fue intervenida para retirar la prótesis, y presentó perforación esofágica. Fue reintervenida, se realizó el lavado de herida quirúrgica y se le colocó sistema VAC. Evolucionó de forma satisfactoria, por lo que egresó por mejoría. Resultados: La perforación cervical posterior a cirugía anterior de columna cervical es una complicación poco frecuente, y es indispensable su reconocimiento y diagnóstico temprano. Conclusiones: La perforación esofágica posterior a la fijación anterior de columna cervical es una complicación muy rara, con una incidencia de 0.25%, cuya mortalidad es elevada de no ser diagnosticada de manera temprana.

Abstract Introduction: The anterior cervical spine surgery is a routine procedure for the fixation of unstable vertebral fractures; the indications for stabilization of the vertebrae are osteomyelitis, spinal tumors and trauma. Objective: To inform about one of the rare and potentially dangerous complications of the cervical spine fixation by anterior approach. Patients and methods: CASE 1: A 41 year-old male patient who had a car accident. The tomography shows a fracture of the anterior arch of C1 and a spinous process fracture of C5-C6. He underwent surgery, and osteosynthesis with plate fixation was placed. A month later he presented esophageal perforation, and underwent surgery again. Osteosynthesis was removed, drainage was performed and a VAC system was placed. He was discharged by adequate evolution. CASE 2: A 53 year-old female patient, began her condition a month earlier with cervicodorsal pain. A magnetic resonance was performed finding disc herniation C4-C5, C5-C6. An arthroplasty with prosthesis in C4-C5 was performed. Five months later, she presented migration of the prosthetic implant and underwent surgery again to remove the prosthesis, presenting esophageal perforation. The surgical wound was washed and a VAC system was placed with satisfactory evolution. Results: A cervical perforation after an anterior cervical spine surgery is a rare complication; an early diagnosis is crucial.

Diagnosis and treatment of late spontaneous esophageal rupture:a report of 10 cases / 中国基层医药

Objective To summarize and analyze the clinical features,diagnostic methods and treatment measures of patients with advanced spontaneous esophageal rupture. Methods Retrospective analysis of clinical characteristics of 10 patients with advanced spontaneous esophageal rupture was conducted. Results The average age of the patients was 49. 3 years old. The average time of diagnosis was 82. 6 hours. The cause of onset was drastic vomiting except for one case falling down. The main clinical manifestations were chest pain,abdominal pain,and shortness of breath,fever and elevation of hemogram,pleural effusion appeared in all patients,1 case was not treated in time,and 9 cases of the first checks were delayed for diagnosis and treatment in other specialties. Conservative treatment(closed thoracic drainage,gastrointestinal decompression,enteral nutrition support and antimicrobial therapy) was given to all patients. All 10 cases were cured by conservative treatment,the average time of hospitalization was 49. 4 days,followed up for 2 years, no chronic empyema, stricture of the esophagus and reflux esophagitis were observed. Conclusion Late spontaneous rupture of the esophagus is caused by delays in the diagnosis and treatment of the esophagus,the effect of comprehensive conservative treatment is satisfactory.

Risk factors predicting development of complications in 72 dogs with esophageal foreign bodies / 대한수의학회지

The aim of this study was to determine predictive risk factors implicated in complications in dogs with esophageal foreign bodies. Medical records of 72 dogs diagnosed with esophageal foreign bodies by endoscopy were reviewed retrospectively. Factors analyzed included age; breed; gender; body weight, location, dimension, and type of foreign body; and duration of impaction. To identify risk factors associated with complications after foreign body ingestion, categorical variables were analyzed using the chi-square or Fisher's exact tests and multivariate analysis, as appropriate. Complications secondary to esophageal foreign body ingestion included megaesophagus, esophagitis, perforation, laceration, diverticulum, and pleuritis. Univariate analysis revealed that the location and duration of impaction after foreign body ingestion were associated with an increased risk of esophageal laceration and perforation. Multivariate analysis showed that age, duration of impaction, and foreign body dimension were significant independent risk factors associated with the development of complications in dogs with esophageal foreign bodies. In conclusion, these results showed that longer duration of impaction and larger foreign body dimensions may increase the risks of esophageal laceration, perforation, and plueritis in dogs.

Successful Treatment Using Endoluminal Vacuum Therapy after Failure of Primary Closure in Boerhaave Syndrome / 대한소화기학회지

Boerhaave syndrome is a transmural perforation of the esophagus and typically occurs after forceful emesis. Boerhaave syndrome is a destructive disease with a high mortality rate, though surgical intervention within 24 hours has a beneficial effect. On the other hand, late surgical intervention is associated with poorer prognoses. Several therapeutic strategies, ranging from medical to surgical management, are available for Boerhaave syndrome. Recently, endoscopic endoluminal vacuum therapy (EVT) was introduced as a treatment option. Here, we report the case of a 56-year-old male patient with Boerhaave syndrome who was successfully treated by EVT after primary closure failure. The patient recovered without complication.

Esophageal Perforation after Anterior Cervical Spine Surgery

STUDY DESIGN: Retrospective case analyses.PURPOSE: To investigate the causes, diagnosis, and management of esophageal perforation, depending on the time of diagnosis.OVERVIEW OF LITERATURE: To date, few studies have addressed these issues.METHODS: A total of seven patients were included in this study. The patients were classified into three groups based on esophageal perforation diagnosis time: intraoperative (diagnosed during surgery), perioperative (diagnosed within 30 days postoperatively), and delayed (diagnosed >30 days postoperatively) groups.RESULTS: In the intraoperative group (N=2), infectious spondylitis was the main cause of esophageal perforation. Anterior plate and screw removal, followed by posterior instrumentation, was performed. The injured esophagus was managed by omentum flap repair in one patient and primary repair in one patient. In the perioperative group (N=2), revision surgery for infection and metal failure were the main causes of esophageal perforation. In both cases, food residue was drained on the third postoperative day. The injured esophagus was managed conservatively. In the delayed group (N=3), chronic irritation caused by metal failure was the main cause of esophageal perforation. In all patients, there was no associated infection. The anterior instrumentation was removed, and the two patients were treated by primary repair, and one patient was treated using sternocleidomastoid muscle flap. One patient in intraoperative group died of sepsis.CONCLUSIONS: The main cause of intraoperative esophageal perforation was esophageal adhesions because of infectious spondylitis. However, perioperative and delayed esophageal perforations were caused by chronic irritation because of metal failure. Anterior plate and screw removal was necessary, and posterior instrumentation and fusion may be considered, depending on the fusion status.