Esophagectomy in esophageal perforations: an analysis.

This study aimed to study the factors that are associated with urgent esophagectomy for the treatment of esophageal perforations and the impact of this therapy. A retrospective review of all esophageal perforations treated at a tertiary care hospital from January 1984 to January 2012 was performed. Compiling demographics, cause and site of perforations, time to presentation, comorbidities, radiological tests, the length of perforation, the hemodynamic status of the patient, type of treatment required, and outcomes were performed. Univariate, multivariate, and Cox regression analyses were conducted. Of 127 cases of esophageal perforation, it was spontaneous in 44 (35%), iatrogenic in 53 (44%), foreign body ingestion in 22 (17%), and traumatic perforation in 7 (6%) cases. Overall, 85 of the 127 (67%) patients were managed operatively, 35 (27.6%) patients were treated conservatively, and 7 (6.3%) patients were treated by endoscopic stent placement. Of the 85 patients who were managed operatively, 21 (16.5%) required esophagectomies, 13 (15.3%) had esophagectomy with immediate reconstruction, 5 (5.9%) patients had esophagectomy followed by delayed reconstruction, and 3 (3.5%) patients failed primary repair and required an esophagectomy as a secondary definitive procedure. Multivariate analysis revealed that esophagectomy in esophageal perforations was associated with the presence of benign or malignant esophageal stricture (P = 0.001) and a perforation >5 cm (P = 0.001). Mortality was mainly associated with the presence of a benign or malignant esophageal stricture (P = 0.04). The presence of pre-existing benign or malignant stricture or large perforation (>5 cm) is associated with the need for an urgent esophagectomy with or without immediate reconstruction. Performing esophagectomy was not found to be a significant prognosticator for mortality.

Mesenteric venous thrombosis and factors associated with mortality: a statistical analysis with five-year follow-up.

OBJECTIVE: The objective was to study the factors associated with mortality in mesenteric venous thrombosis (MVT). METHODS: We reviewed all cases of bowel ischemia at our institute from 1984 to 2004 and identified 31 cases of MVT and compiled data concerning their demographics, risk factors, investigations, management, surgical procedures, and outcomes. Survival was analyzed for both 30-day and 5-year periods. RESULTS: Analysis of factors associated with mortality in our 31 case series revealed that 30-day mortality was strongly associated with colonic involvement in ischemia (p = .008) as well as short bowel syndrome (p = .028) and possibly failure to anti-coagulate the patient (p = .07). While 5-year mortality was strongly associated with "short bowel syndrome" as defined by small bowel remaining less than 100 cm (p = .031). Further study using a multivariate Cox proportional hazard analysis showed that mortality within the 30-day period was mainly related to colon ischemia with p value of .014 and an odds ratio of 17.4, while short-bowel syndrome was the predominated factor in the 5-year mortality analysis with a p value of .029 and an odds ratio of 5. CONCLUSION: Thirty-day mortality for MVT is strongly associated with colonic involvement as well as "short-bowel" syndrome, while anticoagulation may be protective. Five-year survival was found to be strongly associated with "short-bowel" syndrome.