Treatment of esophageal perforation: A review of our experience at a tertiary referral hospital spanning the past 19 years.

INTRODUCTION AND AIMS: Esophageal perforation is an uncommon event that is a medical/surgical emergency, with a 15-30% mortality rate. The aim of the present study was to communicate our experience in the management of esophageal perforation, evaluating the different strategies utilized, in an effort to establish measures to guide decision-making in selecting treatment. MATERIALS AND METHODS: A retrospective descriptive study was conducted on patients diagnosed with esophageal perforation at our hospital center, within the time frame of 2000 and 2019. RESULTS: Over the past 19 years, 15 patients were diagnosed with esophageal perforation. Surgical treatment was carried out in 80% of the cases. Primary closure, reinforced with plasty, was performed in 67% of the patients, of whom 62.5% had early diagnosis and a 100% survival rate. Diagnosis was late in 37.5% of the cases, with a 33.3% survival rate. Esophagectomy and gastric pull-up were performed on 25% of the patients, 66.6% of whom had early diagnosis and a 100% survival rate. In the 33.3% that had late diagnosis, the mortality rate was 100%. Esophagectomy, with cervical esophagostomy and feeding jejunostomy, was performed on one of the patients (8.3%) that had early diagnosis and a 100% survival rate. CONCLUSIONS: The main survival predictor in esophageal perforation is the interval of time between the injury and its diagnosis, and in turn, the resulting treatment. Each patient with esophageal perforation should have individualized treatment to adequately manage the condition.

[Sclerosing cholangitis in a patient with acquired immunodeficiency syndrome]. / Colangitis esclerosante en un paciente con síndrome de inmunodeficiencia adquirida.

The case of a man with the acquired immunodeficiency syndrome who had been intravenous drug abuser is reported. He was investigated because of the presence of both severe upper abdominal pain and raised levels of serum alkaline phosphatase and gamma-glutamyltransferase. The endoscopic retrograde cholangiopancreatography show stenosis of the major duodenal papilla associated with thickening and dilatation of intrahepatic bile ducts. The sclerosing cholangitis (SC) diagnostic was made with histological confirmation. Cryptosporidium oocysts were identified in sputum and bronchial lavage. We discuss his SC implication and we review the literature. We highlight the need to suspect this pathology in both positive serology human immunodeficiency patients or AIDS with abdominal pain and biochemical cholestasis.