ABSTRACT
BACKGROUND: Perforations of the hypopharynx and the cervical oesophagus are infrequent severe situations, which may even be life-threatening for patients. METHODS: We review seven cases of intraluminal perforations of the hypopharynx or cervical oesophagus treated at our department between 1999 and 2001. RESULTS: In this series of patients, foreign bodies were the main cause of perforation. In four cases, the treatment was surgical by means of a cervicotomy and/or thoracotomy and drainage; in the other three cases, conservative treatment was applied. In some cases, the morbidity was considerable but there were no mortalities. CONCLUSIONS: The treatment of perforations of the hypopharynx and the cervical oesophagus must be individualized and multidisciplinary. The early diagnosis of these perforations is an important factor for prognosis.
Subject(s)
Esophageal Perforation/therapy , Hypopharynx/injuries , Adult , Aged , Esophageal Perforation/etiology , Female , Foreign Bodies/complications , Humans , Male , Middle Aged , RuptureABSTRACT
Perforation of the cervical esophagus is a serious circumstance. Mediastinitis secondary to esophageal perforations is associated with high mortality. There is a lack of consensus on the optimal treatment for this condition. We present a case of conservative treatment in an 82-year-old woman with cervical esophagus rupture associated with mediastinal abscess and bilateral pleural effusion resulting from dilatation of a malignant esophageal stricture. Conservative treatment consisted on broad-spectrum intravenous antibiotic therapy, antireflux measures and gastrostomy was satisfactory. Treatment of the esophageal perforation should be individualized to the circumstances of each patient. Advances in antibiotic and nutritional therapy, early institution of treatment and observance of the indications, made possible a more frequent use of a conservative therapeutic approach.
Subject(s)
Abscess/therapy , Anti-Bacterial Agents/therapeutic use , Esophageal Neoplasms/complications , Esophageal Perforation/therapy , Mediastinal Diseases/therapy , Pleural Effusion, Malignant/therapy , Abscess/drug therapy , Abscess/etiology , Aged , Aged, 80 and over , Esophageal Perforation/etiology , Female , Gastrostomy , Humans , Mediastinal Diseases/drug therapy , Mediastinal Diseases/etiology , Pleural Effusion, Malignant/drug therapy , Pleural Effusion, Malignant/etiology , Treatment OutcomeABSTRACT
BACKGROUND: Laryngeal paragangliomas are very rare neoplasms derived from the superior or inferior laryngeal paraganglia. The paragangliomas of the inferior laryngeal paraganglion, depending on their anatomic variability, can give rise to two different clinical expressions of the same process, namely the so-called thyroid paragangliomas and the inferior laryngeal or subglottic paragangliomas. METHODS: We present a case for which we have not found any previous descriptions of a cervical and subglottictracheal relapse of a thyroid paraganglioma removed 3 years earlier. We review the literature. RESULTS: We have found a total of 22 paragangliomas of the inferior laryngeal paraganglia, 23 including our case. CONCLUSIONS: Thyroid paragangliomas and inferior laryngeal or subglottic paragangliomas should be included under the term "paragangliomas" of the inferior laryngeal paraganglion. These tumors are slow growing, benign, hypervascular, and much more common in middle-aged women. Immunohistochemistry is essential for its diagnosis. Open, conservative surgery is the treatment of choice.
