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1.
Rev. colomb. cir ; 37(2): 237-244, 20220316. tab, fig
Article in Spanish | LILACS | ID: biblio-1362955

ABSTRACT

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.


Subject(s)
Humans , Thorax , Esophageal Perforation , Trachea , Wounds and Injuries , Mediastinum
2.
J. vasc. bras ; 21: e20220012, 2022. graf
Article in Portuguese | LILACS | ID: biblio-1386126

ABSTRACT

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.


Subject(s)
Humans , Female , Adult , Carotid Artery Injuries/surgery , Eating , Esophageal Perforation/complications , Retropharyngeal Abscess , Carotid Artery Injuries/complications , Carotid Artery Injuries/diagnosis , Esophageal Perforation/mortality , Mediastinitis/mortality
3.
Rev. méd. Urug ; 37(2): e37210, 2021. graf
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1289849

ABSTRACT

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.


Subject(s)
Male , Middle Aged , Esophageal Perforation , Spontaneous Perforation
4.
Rev. cuba. cir ; 59(4): e1015, oct.-dic. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1149852

ABSTRACT

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)


Subject(s)
Humans , Male , Middle Aged , Emergencies , Esophageal Perforation/diagnostic imaging , Esophagus/injuries , Rupture, Spontaneous/therapy , Survival
5.
Rev. gastroenterol. Perú ; 39(1): 7-11, ene.-mar. 2019. ilus, tab
Article in English | LILACS | ID: biblio-1014120

ABSTRACT

Background: Esophageal stricture is one of the most important complication of the caustic ingestion. Objective: The aim of this study was to evaluate complications of balloon dilatation among children with esophageal stenosis. Material and methods: In this retrospective study 82 children were included. Children who underwent balloon dilatation for esophageal stenosis were included in our study. Duration of study was 14 year starting from 2001. Mean age of the cases was 3.95±0.4 year (Min: 15 days, Max: 14 year). Chart review and telephone calling were the methods of data collection. Data was analyzed using SPSS. Results: In this study, 47% of the patients were male and 53% of the cases were female. Caustic ingestion (33.7%) was the most common etiology for the esophageal stricture. Vomiting (87.8%) was the most common presenting symptom. Among our cases, 76.8% had no compliant after esophageal dilatation. Chest pain was the most common compliant after esophageal dilatation. Response rate was similar among boys and girls. Toddler age had the best treatment response after esophageal dilatation. Conclusion: Among our cases, 76.8% had no post procedural compliant after esophageal dilatation. Esophageal perforation was seen in 4.9% of the cases. Chest pain was the most common post dilatation complication.


Antecedentes: La estenosis esofágica es una de las más importantes complicaciones de la ingesta de caústicos. Objetivo: El objetivo del estudio fue evaluar las complicaciones de la dilatación endoscópica con balón en niños con estenosis esofágica. Material y métodos: En este estudio retrospectivo se incluyeron 82 niños. Se incluyeron todos los niños que se sometieron a una dilatación endoscópica con balón por estenosis esofágica. La duración del estudio fue 14 años iniciando en el año 2001. La edad media de los pacientes fue 3,95 +/- 0,4 años (Min. 15 días, Máx. 14 años). La recolección de datos se realizó revisando las historias clínicas y con llamadas telefónicas. Los datos se analizaron con el Sistema SPSS. Resultados: En este estudio, 47% de los casos fueron varones y 53% fueron mujeres. La ingesta de caústicos fue la causa más frecuente de estenosis esofágica (33,7%). El síntoma más común fueron los vómitos (87,8%). Entre nuestros casos, 76,8% no presentaron molestias luego de la dilatación esofágica. El dolor torácico fue la molestia más común luego de la dilatación esofágica. La tasa de respuesta al tratamiento fue similar entre hombres y mujeres. Los niños pequeños tuvieron la mejor respuesta al tratamiento luego de la dilatación esofágica. Conclusiones: Entre nuestros casos, 76,8% no presentaron molestias luego de la dilatación esofágica. La perforación esofágica se presentó en 4,9% de los casos. El dolor torácico fue la complicación más común posterior a la dilatación.


Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Chest Pain/etiology , Esophagoscopy/adverse effects , Dilatation/adverse effects , Esophageal Perforation/etiology , Esophageal Stenosis/therapy , Vomiting/etiology , Burns, Chemical/therapy , Esophageal Achalasia/complications , Retrospective Studies , Esophageal Stenosis/congenital , Esophageal Stenosis/chemically induced , Tertiary Care Centers/statistics & numerical data , Iran
6.
Article in English | WPRIM | ID: wpr-742158

ABSTRACT

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.


Subject(s)
Endoscopy , Esophageal Perforation , Esophagus , Hand , Humans , Male , Middle Aged , Mortality , Prognosis , Vacuum , Vomiting
8.
Rev. colomb. cir ; 34(2): 190-198, 20190000. fig
Article in Spanish | LILACS, COLNAL | ID: biblio-999223

ABSTRACT

La perforación concomitante de esófago y aorta se puede presentar después de la ingestión de cuerpos extraños. El reparo aórtico por técnica endovascular, a pesar de ser reciente, es un tratamiento de primera línea por tratarse de un abordaje poco invasivo, rápido y que permite la estabilización hemodinámica, en comparación con la reparación abierta tradicional. Se presentan dos casos de perforación aórtica, en los cuales se llevó a cabo el reparo endovascular con éxito. El primer paciente sufrió una ruptura contenida de la aorta torácica, secundaria a la ingestión de un cuerpo extraño (espina de pescado), y presentó mediastinitis. El segundo paciente sufrió una ruptura aórtica en el arco distal a la arteria subclavia, la cual se corrigió por vía endovascular, pero desarrolló una fístula aorto-esofágica y, finalmente, murió


Concomitant esophageal and aortic perforation has been described in the literature as major complications of foreign body ingestion. Although it has not been widely studied, aortic endovascular repair is the first line of treatment, for it is less invasive, faster and allows early patient stabilization, as compared with the traditional open repair. We present two cases managed successfully with endovascular repair of the aortic perforation. The first case had a contained rupture of the thoracic aorta caused by the ingestion of a foreign body (fish bone) and developed mediastinitis. The second case had an aortic rupture in the arc distal to the subclavian artery, managed with endovascular but he developed an aortoesophageal fistula which was finally lethal.


Subject(s)
Humans , Aortic Rupture , Aneurysm, False , Esophageal Perforation , Endovascular Procedures
9.
Asian Spine Journal ; : 976-983, 2019.
Article in English | WPRIM | ID: wpr-785488

ABSTRACT

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.


Subject(s)
Diagnosis , Esophageal Perforation , Esophagus , Humans , Omentum , Retrospective Studies , Sepsis , Spine , Spondylitis
10.
Article in English | WPRIM | ID: wpr-760341

ABSTRACT

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.


Subject(s)
Animals , Body Weight , Diverticulum , Diverticulum, Esophageal , Dogs , Eating , Endoscopy , Esophageal Achalasia , Esophageal Perforation , Esophagitis , Foreign Bodies , Lacerations , Medical Records , Multivariate Analysis , Pleurisy , Retrospective Studies , Risk Factors
11.
RELAMPA, Rev. Lat.-Am. Marcapasso Arritm ; 31(2)abr.-jun. 2018. ilus, tab, graf
Article in Portuguese | LILACS | ID: biblio-914107

ABSTRACT

Lesões do esôfago são descritas como complicação da ablação por radiofrequência da fibrilação atrial. Os trabalhos que avaliaram a formação das lesões esofágicas em ablações de fibrilação atrial tiveram como padrão de fonte de energia a radiofrequência em modo unipolar, utilizando o cateter irrigado. Atualmente está disponível o cateter circular multipolar (PVAC-GOLD®), que utiliza ciclos de aplicação de energia em fases (Duty-Cycled Phased RF). Este trabalho tem como objetivo avaliar a ocorrência de lesão esofágica em pacientes submetidos a ablação de fibrilação atrial utilizando-se o cateter PVAC-GOLD®. Método: Entre agosto de 2014 e agosto de 2017, foram incluídos pacientes submetidos a ablação de fibrilação atrial sintomática com uso do cateter PVAC-GOLD®. Por meio da realização de endoscopia digestiva alta no pós-operatório, buscou-se determinar a ocorrência de lesão esofágica térmica associada ao procedimento. Resultados: O estudo incluiu um total de 117 pacientes (74% com fibrilação atrial paroxística), com média de idade de 54,8 anos, e predominantemente do sexo masculino. Destes, apenas 2 apresentaram lesões esofágicas térmicas diagnosticadas por meio da endoscopia digestiva alta. Conclusão: A lesão esofágica parece ser um achado incomum em pacientes submetidos a isolamento elétrico das veias pulmonares com o cateter circular multipolar (PVAC-GOLD®)


Esophageal lesions are described as a complication after ablation for atrial fibrillation. The studies evaluating the development of esophageal lesions in ablation due to atrial fibrillation had unipolar mode radiofrequency energy source using an irrigated catheter. A multipolar pulmonary vein ablation catheter (PVAC-GOLD®) is currently available, which uses phase-in cycles of energy (Duty-Cycled Phased RF). This study aims to evaluate the occurrence of esophageal lesions in patients undergoing ablations due to atrial fibrillation using the PVAC-GOLD® catheter. Method: Between August 2014 and August 2017, patients undergoing ablation due to symptomatic atrial fibrillation with the use of the PVAC-GOLD® catheter were included in the study. Upper digestive endoscopy was performed in the postoperative period to determine the presence of thermal esophageal lesions associated to the procedure. Results: A total of 117 patients, with mean age of 54.8 years, predominantly males, were included in the study. Of these patients, only 2 presented thermal esophageal lesions diagnosed by endoscopy. Conclusion: Esophageal lesion seems to be an unusual finding in patients undergoing electrical isolation of the pulmonary veins using the multipolar pulmonary vein ablation catheter (PVAC-GOLD®)


Subject(s)
Humans , Male , Female , Middle Aged , Atrial Fibrillation , Catheter Ablation/methods , Esophageal Fistula/complications , Echocardiography, Transesophageal/methods , Endoscopy, Digestive System/methods , Esophageal Perforation , Esophagus/injuries , Heart Atria/diagnostic imaging , Prospective Studies , Pulmonary Veins , Radio Waves/therapeutic use , Data Interpretation, Statistical
12.
Clinical Endoscopy ; : 186-191, 2018.
Article in English | WPRIM | ID: wpr-713156

ABSTRACT

Boerhaave syndrome (BS) is a spontaneous esophageal perforation which carries high mortality. Surgical treatment is well established, but the development of interventional endoscopy has proposed new therapies. We expose our experience in a Gastrointestinal and Endoscopy Unit. With a retrospective, observational, open-label, single center, consecutive case series. All patients diagnosed with BS who were managed in our center were included. Treated conservatively, endoscopically or surgically, according to their clinical condition and lesion presentation. Fourteen patients were included. Ten were treated with primary surgery. One conservatively. In total, 7/14 patients required an endoscopic treatment. All required metallic stents deployment, 3 cases over-the-scope-clips concomitantly and one case a novel technique an internal drain. 6/7 cases endoscopically treated achieved complete esophageal healing. In conclusion, endoscopy is an useful tool at all stages BS management: difficult diagnosis, primary treatment in selected patients and as salvage when surgery fails. With mortality rates and outcomes comparables to surgery.


Subject(s)
Diagnosis , Endoscopy , Esophageal Perforation , Humans , Minimally Invasive Surgical Procedures , Mortality , Retrospective Studies , Stents , Surgical Instruments
13.
Article in English | WPRIM | ID: wpr-742315

ABSTRACT

Early diagnosis followed by primary repair is the best treatment for spontaneous esophageal perforation. However, the appropriate management of esophageal leakage after surgical repair is still controversial. Recently, the successful adaptation of vacuum-assisted closure therapy, which is well established for the treatment of chronic surface wounds, has been demonstrated for esophageal perforation or leakage. Conservative treatment methods require long-term fasting with total parenteral nutrition or enteral feeding through invasive procedures, such as percutaneous endoscopic gastrostomy or a feeding jejunostomy. We report 2 cases of esophageal leakage after primary repair treated by endoscopic vacuum therapy with continuous enteral feeding using a Sengstaken-Blakemore tube.


Subject(s)
Early Diagnosis , Endoscopy , Enteral Nutrition , Esophageal Perforation , Fasting , Gastrostomy , Jejunostomy , Negative-Pressure Wound Therapy , Parenteral Nutrition, Total , Vacuum , Wounds and Injuries
14.
Rev. chil. cir ; 70(5): 460-463, 2018. ilus
Article in Spanish | LILACS | ID: biblio-978016

ABSTRACT

Resumen Introducción: La perforación esofágica es una posible complicación de la artrodesis cervical anterior. Sin embargo, estas suelen ocurrir intraoperatoriamente o en el posoperatorio precoz. Caso clínico: Mujer de 35 años sometida, 3 años antes, a artrodesis de C3-C5, que tras sufrir un traumatismo leve con latigazo cervical, comienza con disfagia. Se objetiva un absceso retroesofágico por perforación esofágica, causado por rotura de la placa protésica y extrusión de un tornillo.


Introduction: Esophageal perforation is a possible complication after anterior cervical fusion. However, these complications usually appear intraoperatively or in the early postoperative course. Case report: A 35-years-old females, who underwent a C3-C5 anterior cervical fusion 3 years ago, after suffering a mild cervical trauma, she complained of dysphagia. A retroesophageal abscess was observed, caused by esophageal perforation, secondary to plaque rupture and screw extrusion.


Subject(s)
Humans , Female , Middle Aged , Spinal Fusion/adverse effects , Esophageal Perforation/surgery , Esophageal Perforation/etiology , Arthrodesis/adverse effects , Magnetic Resonance Imaging , Treatment Outcome , Esophageal Perforation/diagnostic imaging
15.
Clinical Endoscopy ; : 61-65, 2018.
Article in English | WPRIM | ID: wpr-739691

ABSTRACT

BACKGROUND/AIMS: Currently, a new over-the-scope clip (OTSC) system has been introduced. This system has been used for gastrointestinal perforations and fistulas in other countries. The aim of our study is to examine the therapeutic success rate of endoscopic treatment using the OTSC system in Korea. METHODS: This was a multicenter prospective study. A total of seven endoscopists at seven centers performed this procedure. RESULTS: A total of 19 patients were included, with gastrointestinal leakages from anastomosis sites, fistulas, or esophageal perforations due to Boerhaave’s syndrome. Among these, there were three gastrojejunostomy sites, three esophagojejunostomy sites, four esophagogastrostomy sites, one esophagocolonostomy site, one jejuno-jejunal site, two endoscopic full thickness resection site closures, one Boerhaave’s syndrome, two esophago-bronchial fistulas, one gastrocolonic fistula, and one colonopseudocyst fistula. The size of the leakage ranged from 5 to 30 mm. The median procedure time was 16 min. All cases were technically successful. Complete closure of the leak was achieved in 14 of 19 patients using OTSC alone. CONCLUSIONS: The OTSC system is a safe and effective method for the management of gastrointestinal leakage, especially in cases of anastomotic leakage after surgery.


Subject(s)
Anastomotic Leak , Esophageal Perforation , Fistula , Gastric Bypass , Humans , Korea , Methods , Prospective Studies
16.
Article in Korean | WPRIM | ID: wpr-715647

ABSTRACT

The most common cause of esophageal foreign bodies in adults is meat in Western countries and fish bones in Asian countries, including Korea. Although most ingested foreign bodies pass spontaneously through the esophagus without any clinical sequelae, some sharp foreign bodies, such as fish bones embedded in the esophagus, require treatment. Endoscopic management is the first choice in the treatment of esophageal foreign bodies because it is quite safe and effective. Major complications occur as a result of esophageal perforation; in particular, sharp foreign bodies, such as fish bones, are more likely to cause perforation. Complications include mediastinitis, paraesophageal abscess, pneumomediastinum, subcutaneous emphysema, pneumothorax, tracheoesophagal fistula, aortoesophageal fistula, aspiration, and asphyxia. Unnecessary delays should be avoided in endoscopic intervention for esophageal foreign bodies to prevent complications.


Subject(s)
Abscess , Adult , Asians , Asphyxia , Esophageal Perforation , Esophagus , Fistula , Foreign Bodies , Humans , Korea , Meat , Mediastinal Emphysema , Mediastinitis , Pneumothorax , Subcutaneous Emphysema
17.
Article in English | WPRIM | ID: wpr-715125

ABSTRACT

Perforation of the esophagus is an uncommon problem with significant morbidity and mortality. In children undergoing endoscopy, the risk of perforation is higher when interventional endoscopy is performed. The clinical features depend upon the site of esophageal perforation. Opinions vary regarding the optimal treatment protocol, and the role of conservative management in this context is not well established. Esophageal perforation that occurs as a consequence of endoscopy in children requires careful evaluation and management, as outlined in this article.


Subject(s)
Child , Clinical Protocols , Endoscopy , Esophageal Perforation , Esophagoscopy , Esophagus , Foreign Bodies , Humans , Mortality
18.
Medisan ; 21(11)nov. 2017. tab
Article in Spanish | LILACS | ID: biblio-894574

ABSTRACT

Se realizó un estudio descriptivo y transversal de 30 pacientes con mediastinitis aguda por perforación esofágica, operados en el Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, con vistas a caracterizarles desde los puntos de vista clínico, diagnóstico y quirúrgico, desde enero de 1990 hasta agosto de 2016. La incidencia de la enfermedad fue de 37,9 por cada 100 000 habitantes con predominio de los pacientes jóvenes, en los cuales la esofagoscopia terapéutica por cuerpo extraño de difícil extracción fue la causa más frecuente de la perforación torácica, acompañada de síntomas y signos de síndrome esofágico y de sepsis, asociada a la presencia de estafilococos y estreptococos. La tomografía computarizada constituyó el examen de mayor valor para el diagnóstico, en tanto, los diferentes hallazgos durante la intervención quirúrgica estuvieron en dependencia del grado de infección mediastinal. Se necesita un conocimiento exhaustivo de los antecedentes, la clínica y posibles resultados de los exámenes complementarios para asumir una conducta rápida y eficaz, a fin de lograr la disminución de la mortalidad por dicha afección


A descriptive and cross-sectional study of 30 patients with acute mediastinitis due to esophageal perforation, who were surgically intervened at Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital was carried out in Santiago de Cuba from January, 1990 to August, 2016, aimed at characterizing them from the clinical, diagnostic and surgical points of view. The incidence of the disease was 37.9 out of 100 000 inhabitants with the young patients prevalence, in which the therapeutic esophagoscopy due to strange body of difficult extraction was the most frequent cause in the thoracic perforation, accompanied by symptoms and signs of esophageal syndrome and sepsis, associated with the staphylococci and streptococci presence. The computerized axial tomography constituted the exam of more value for the diagnosis, as long as, the different findings during the surgical intervention were in dependence of the grade of mediastinal infection. An exhaustive knowledge of the history, clinic and possible results of the complementary exams is necessary to assume a quick and effective behaviour, in order to achieve the decrease of mortality due to this disorder


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Surgical Procedures, Operative , Morbidity , Esophageal Perforation/mortality , Mediastinitis/epidemiology , Secondary Care , Epidemiology, Descriptive , Cross-Sectional Studies , Foreign Bodies/complications , Mediastinitis
19.
Rev. cuba. cir ; 56(3): 1-9, jul.-set. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-900988

ABSTRACT

Introducción: la mediastinitis aguda constituye una complicación grave de la perforación esofágica. No existen clasificaciones ni pautas generales para su tratamiento. Objetivo: desarrollar una clasificación evolutiva, y un algoritmo de tratamiento quirúrgico. Métodos: se efectuó una investigación en el Hospital Provincial Saturnino Lora, de Santiago de Cuba, desde 1990 hasta el 2014. Se utilizó la prueba chi cuadrado de homogeneidad para la validación de los resultados, así como el porcentaje como medida de resumen y el calcula de las tasas de incidencia y de mortalidad. El estudio incluyó dos diseños metodológicos: el primero, de desarrollo tecnológico, para la elaboración de la clasificación y el algoritmo de tratamiento, y un cuasiexperimento, para la aplicación del algoritmo. Resultados: se identificó que en los estados más severos de la mediastinitis aguda, la mortalidad es más elevada. La carga de mortalidad para el primer grupo de pacientes fue del 77,7 por ciento y descendió al 22,3 por ciento en el grupo tratado con el algoritmo (decremento del riesgo del 64,8 por ciento). Conclusiones: la clasificación evolutiva pauta la implementación del algoritmo de tratamiento quirúrgico de la enfermedad. La aplicación del algoritmo de tratamiento quirúrgico de la mediastinitis aguda por perforación esofágica permite disminuir la carga de morbilidad. En consecuencia, disminuye de forma relevante el riesgo de morir por esta enfermedad(AU)


Introduction: acute mediastinitis is a serious complication of esophageal perforation. There are no classifications or general guidelines for its treatment. Objective: to develop an evolutionary classification and a surgical treatment algorithm. Methods: aresearch was carried out at Saturnino Lora Provincial Hospital in Santiago de Cuba, from 1990 to 2014. The chi-square homogeneity test was used for the validation of the results, as well as the percentage as a summary measure and the calculation of incidence rates and mortality. The study included two methodological designs: the first, technological development, for the elaboration of the classification and the treatment algorithm, and a quasi-experiment for the application of the algorithm. Results: in the more severe states of acute mediastinitis, mortality was identified as higher. The mortality load for the first group of patients was 77.7 percent and decreased to 22.3 percent in the group treated with the algorithm (risk reduction of 64.8 percent). Conclusions: the evolutionary classification guides the implementation of the surgical treatment algorithm of the disease. The application of the surgical treatment algorithm of acute mediastinitis through esophageal perforation allows reducing the burden of morbidity. Consequently, the risk of dying from this disease decreases significantly(AU)


Subject(s)
Humans , Esophageal Perforation/therapy , Esophagectomy/methods , Mediastinitis/complications , Morbidity
20.
Medisan ; 21(8)ago. 2017.
Article in Spanish | LILACS | ID: biblio-997598

ABSTRACT

En situaciones de urgencia, la cirugía constituye un desafío a la pericia de los cirujanos, sobre todo cuando se trata de la perforación del esófago, que es una de las roturas orgánicas más graves y complejas de todo el tracto digestivo. Esto ocurre debido a las características anatómicas del órgano, que además, está rodeado de tejidos laxos y cavidades fasciales virtuales; por ello, su perforación permite que la infección se disemine rápidamente en el mediastino, la pleura y el pericardio, lo cual provoca que la mortalidad por mediastinitis aguda sobrepase el 60 por ciento.


Surgery constitutes a challenge to surgeons skill, in situations of emergency mainly when it is an esophageal perforation which is one of the most serious and complex organic breaks in the whole digestive tract. This happens due to the anatomical characteristics of the organ that is also surrounded by relaxed tissues and virtual fascia cavities; reason why, its perforation allows the infection to be quickly disseminated in the mediastinal cavity, pleura and pericardium, which causes that mortality due to acute mediastinitis exceeds the 60 percent.


Subject(s)
Humans , Male , Female , Esophageal Perforation/etiology , Esophageal Perforation/mortality , Mediastinitis/complications , Communication
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