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3.
Medicine (Baltimore) ; 99(2): e18765, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914100

RESUMO

RATIONALE: Acute chest pain remains one of the most challenging complaints of patients presenting to emergency departments (EDs). The diverse etiologies of chest pain frequently lead to diagnostic and therapeutic challenges. Esophageal perforation is a rare but potentially life-threatening disease. It results in delayed diagnosis and an estimated mortality risk of 20% to 40%. Prompt diagnosis and immediate therapeutic interventions are key factors for a good prognosis. PATIENT CONCERNS: Case 1 involved a 66-year-old man who presented to the ED with acute chest pain radiating to the back and hematemesis. Emergent contrast thoracic computerized tomography (CT) indicated the presence of a massive pneumothorax with pleural effusion. The continuous drainage of a dark-red bloody fluid following emergent thoracic intubation led to the discovery that the patient had experienced severe vomiting after whiskey consumption before admission to the hospital. Re-evaluation of the CT indicated spontaneous pneumomediastinum, whereas barium esophagography confirmed the presence of an esophageal perforation. Case 2 involved an 18-year-old Vietnamese man admitted to our ED with acute chest pain and swelling of the neck after vomiting due to beer consumption. A chest x-ray indicated diffuse subcutaneous emphysema of the neck and upper thorax. Contrast CT indicated pneumomediastinum with extensive emphysema and air in the paraspinal region and spinal canal. DIAGNOSES: Both of the 2 cases were diagnosed as spontaneous perforation of the esophagus (Boerhaave syndrome [BS]). INTERVENTIONS: Case 1 received surgical interventions, whereas case 2 decided not to avail our medical services. OUTCOMES: Case 1 was discharged after a good recovery. Case 2 lost to follow-up. LESSONS: We recommend all physicians in the ED to raise their index of suspicion for BS when dealing with patients having acute chest pain, dyspnea, confirmed pneumothorax, or newly-developed pleural effusion.


Assuntos
Dor no Peito/etiologia , Perfuração Esofágica/complicações , Perfuração Esofágica/diagnóstico , Doenças do Mediastino/complicações , Doenças do Mediastino/diagnóstico , Idoso , Hematemese/etiologia , Humanos , Masculino
4.
Klin Padiatr ; 232(1): 13-19, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31618788

RESUMO

BACKGROUND: There is a lack of experience with fully covered self-expandable metal stents (SEMSs) for the treatment of esophageal leakage particularly in infants and neonates. METHODS: Eight patients (5M, 3F) with a median age of 17 months (range, 1-135 months) who underwent treatment with SEMSs for an anastomotic leakage or perforation of the esophagus were recruited to this retrospective study. Four children were born premature. In six patients the stents were placed primarily as an emergency procedure. RESULTS: Median duration of individual stent placement was 42 days (range, 13-72 days). Six out of eight patients (75%) were treated with one stent only. In three preterm infants who had their stents inserted within the first month relative weight gain was 17% compared with 2% in five patients who were treated later in life (p=0.0986). In four cases (50%) distal migration of the stent was observed. Seven out of eight patients (88%) had their leakage resolved after stent therapy. CONCLUSIONS: Insertion of fully covered SEMSs is an alternative tool for the treatment of esophageal leakage in children and preterm infants, and successful with only one single application in selected cases. It can be used either following previous therapy or as part of an emergency procedure. Because of the absence of manufactured, age-related devices SEMSs that are originally designed for other organs can be applied.


Assuntos
Fístula Anastomótica/cirurgia , Doenças do Esôfago/cirurgia , Perfuração Esofágica/cirurgia , Esôfago/lesões , Esôfago/fisiopatologia , Stents , Fístula Anastomótica/diagnóstico , Fístula Anastomótica/etiologia , Criança , Pré-Escolar , Dilatação/métodos , Perfuração Esofágica/complicações , Perfuração Esofágica/diagnóstico , Esôfago/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Metais , Estudos Retrospectivos , Resultado do Tratamento
6.
Kyobu Geka ; 72(10): 878-885, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31582714

RESUMO

Spontaneous esophageal rupture was first reported by Boerhaave in 1724 and typically occurs in conjunction with vomiting, retching, or swallowing a large food bolus. This condition is potentially life threatening and causes severe mediastinitis, empyema, and sepsis, unless appropriate and early treatment is initiated. Conventional surgical repair is recommended within 24 hours of initial onset. However, some reports recommend surgery regardless of the time interval since onset. Various surgical procedures, conservative to esophagectomy, have been utilized in clinical practice. These methods include open thoracotomy, thoracoscopic surgery, or the addition of laparotomy. In this chapter the basic method of chest drainage, esophageal repair and reinforcement of suture line by open thoracotomy or thoracoscopic surgery. Surgical results for the treatment of this condition with thoracoscopic surgery are similar to those with conventional thoracotomy. Any procedures should be considered as suitable when selecting the approach used to treat Boerhaave's syndrome with regard to patient condition, status of the esophageal tear, and the surgeon's skills. In any surgical methods, it is important to assess the area of esophageal tear, to suture the esophageal wall appropriately, and to have enough drainage and place chest tubes in the proper position.


Assuntos
Perfuração Esofágica , Doenças do Mediastino , Humanos , Ruptura Espontânea
7.
Kyobu Geka ; 72(11): 893-896, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31588103

RESUMO

A 77-year-old man vomited after alcohol drinking and was sent to our hospital by an ambulance due to sustained chest pain. Chest computed tomography (CT) showed pneumothorax and pleural effusion, and thoracic drainage was performed. Since food residue was found from chest drainage and esophagoscopy and esophagography showed injured potion on the left wall of the lower thoracic esophagus perforating to the left thoracic cavity, a spontaneous esophageal rupture was diagnosed. Establishment of fenestration for open drainage and gastrostomy were performed. After 49 days, the fistula was successfully closed by cleaning of the left thoracic cavity, with application of basic fibroblast growth factor and enteral nutrition through gastrostomy. The fenestration was closed after 53 days and the patient was discharged after 78 days.


Assuntos
Empiema , Perfuração Esofágica , Doenças do Mediastino , Idoso , Drenagem , Fator 2 de Crescimento de Fibroblastos , Humanos , Masculino , Ruptura Espontânea
10.
Thorac Surg Clin ; 29(4): 351-358, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31564391

RESUMO

Paraesophageal hernia repair is a technically challenging operation. Factors that influence morbidity of the operation include the timing of the operation, surgical approach, and patient factors. Medical complications are the most common and usually are respiratory or cardiac related. Perforation, subcutaneous emphysema, pneumothorax, shortened esophagus, and presence of a large hernia all complicate paraesophageal hernia repair. Various strategies of intraoperative management are described. Management of leaks and perforations identified postoperatively are dictated by the clinical status of the patient. Early identification and expeditious intervention are paramount in the overall management of complications.


Assuntos
Perfuração Esofágica/terapia , Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Complicações Intraoperatórias/terapia , Complicações Pós-Operatórias/terapia , Fundoplicatura/métodos , Gastroplastia/métodos , Humanos , Doença Iatrogênica , Laparoscopia , Tratamento de Ferimentos com Pressão Negativa , Pneumotórax/terapia , Recidiva , Estudos Retrospectivos , Stents , Estômago/lesões , Enfisema Subcutâneo/terapia , Resultado do Tratamento
11.
J Med Case Rep ; 13(1): 275, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31477179

RESUMO

BACKGROUND: Eosinophilic esophagitis, once considered a rare disorder, has been increasingly recognized as a leading cause of dysphagia and food impaction in children and adults over the last few decades. It predominantly occurs in young men with a history of atopy. Dysphagia and food impaction are the most common presentations. However, rarely, spontaneous perforation (Boerhaave's syndrome) may occur in association with eosinophilic esophagitis. CASE PRESENTATION: A 40-year-old white woman with known history of eosinophilic esophagitis, who was non-compliant with treatment, presented with chest pain and developed acute spontaneous transmural esophageal perforation while eating a snack. Surgical repair was required. CONCLUSION: In a relatively young patient who presents with spontaneous esophageal perforation, eosinophilic esophagitis should always be ruled out as subsequent treatment may prevent recurrent perforation.


Assuntos
Esofagite Eosinofílica/complicações , Perfuração Esofágica/etiologia , Adulto , Dor no Peito/etiologia , Perfuração Esofágica/cirurgia , Feminino , Humanos , Cooperação do Paciente
13.
BMJ Case Rep ; 12(8)2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31399415

RESUMO

A runner competing in a 100 mile trail race presented with severe lower chest pain and right upper abdominal pain. His pain started immediately after he took an over the counter non steroidal anti-inflammatory pill a few hundred metres after leaving the aid station. When he took the pill, he immediately had to vomit and spit out the pill. On arriving back at the aid station, he was noted to have severe left-sided chest pain that worsened with reclining. He also had profound dyspnoea. Initial vital signs were unremarkable. The runner was immediately transported to an emergency room and eventually found to have an oesophageal rupture. After surgical intervention and a lengthy recovery, the runner is back to participating in sport.


Assuntos
Dor no Peito/etiologia , Perfuração Esofágica/diagnóstico , Doenças do Mediastino/diagnóstico , Adulto , Atletas , Broncoscopia , Diagnóstico Diferencial , Perfuração Esofágica/complicações , Perfuração Esofágica/cirurgia , Humanos , Masculino , Doenças do Mediastino/complicações , Doenças do Mediastino/cirurgia , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/terapia , Corrida
14.
BMC Surg ; 19(1): 109, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409335

RESUMO

BACKGROUND: Boerhaave's syndrome involves a sudden elevation in the intraluminal pressure of the esophagus, causing a transmural perforation. It is associated with high morbidity and mortality. Its treatment is challenging, and early surgical intervention is the most crucial prognostic element. CASE PRESENTATION: We present a case of a 32 year-old male who presented after severe emesis with an acute onset of epigastric pain. He was diagnosed with Boerhaave's syndrome. Displaying signs of shock mandated immediate surgical exploration with laparoscopic primary repair. CONCLUSION: The golden period of the first 24 hrs of the event still applies to cases of esophageal perforation. The scarcity of these cases makes a comparison between the various treatment methods difficult. Our data support the use of laparoscopic intervention with primary repair as the mainstay of treatment for the management of esophageal perforation.


Assuntos
Perfuração Esofágica/cirurgia , Doenças do Mediastino/cirurgia , Dor Abdominal/etiologia , Adulto , Perfuração Esofágica/diagnóstico por imagem , Humanos , Laparoscopia , Masculino , Doenças do Mediastino/diagnóstico por imagem , Resultado do Tratamento , Vômito/etiologia
15.
Artigo em Chinês | MEDLINE | ID: mdl-31434376

RESUMO

Objective: To analyze and summarize the method and effect of cervical esophagus perforation. Methods: A total of 29 cervical esophageal perforation patients caused by foreign body were retrospectively analyzed from January 2012 to June 2018 in Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Nanchang University. Results: Among the 29 cervical esophageal perforation patients, 28 patients were extracted by lateral neck incision, 1 patient with carotid artery hemorrhea was rescued by repairing the fistula between carotid artery and esophage. All patients recovered and successfully discharged. There were no severe complications among all patients. Conclusions: The cervical CT scan is important for diagnosing a cervical esophageal perforation. Enhancement CT scan is necessay for a patient with haematemesis. Lateral neck incision would be first choice for patients with big foreign bodies. Inflammatory reaction and finger palpation are helpful for locating foreign bodies.


Assuntos
Perfuração Esofágica/diagnóstico , Perfuração Esofágica/cirurgia , Corpos Estranhos , Adulto , Perfuração Esofágica/diagnóstico por imagem , Perfuração Esofágica/etiologia , Feminino , Corpos Estranhos/complicações , Humanos , Masculino , Pescoço , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
16.
Early Hum Dev ; 137: 104836, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31437732

RESUMO

BACKGROUND: Iatrogenic gastrointestinal perforations are rare, but life-threatening events in preterm infants. AIM: Aim of the study was to report on incidence, management, morbidity, and mortality. STUDY DESIGN: This was a retrospective analysis performed at a tertiary neonatal intensive care unit in Vienna, Austria. SUBJECTS: Extremely low birth weight infants (ELBW, birth weight < 1000 g) with perforations of the upper gastrointestinal tract (GIT) caused by gastric tubes were included. OUTCOME MEASURES: All ELBW infants born within the 6-year study period were identified and their discharge summaries or notes were screened for esophageal and gastric perforations. Data on incidence, management of GIT perforations, morbidity, and mortality were obtained. RESULTS: During a 6-year study period 646 ELBW infants were analyzed. Incidence of perforations was 1.1% (n = 7/646). Median gestational age was 23 + 3 (range: 23 + 0-24 + 5). Perforations occurred on the third day of life (=median, range: day 2-14) and were primarily managed conservatively. Enteral feeding was stopped for 6 days (range: 4-13 days), antibiotic therapy administered for 16 days (range: 8-22 days). In one infant, gastrorrhaphy was performed. CONCLUSIONS: Conservative treatment of upper GIT perforations led to spontaneous recovery without major complications in 85.7%.


Assuntos
Nutrição Enteral/efeitos adversos , Perfuração Esofágica/terapia , Doença Iatrogênica/epidemiologia , Recém-Nascido de muito Baixo Peso , Perfuração Intestinal/terapia , Áustria , Tratamento Conservador/métodos , Tratamento Conservador/estatística & dados numéricos , Perfuração Esofágica/epidemiologia , Perfuração Esofágica/etiologia , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Perfuração Intestinal/epidemiologia , Perfuração Intestinal/etiologia , Masculino , Morbidade
18.
Ann Clin Lab Sci ; 49(3): 395-399, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31308042

RESUMO

Boerhaave syndrome is a transmural disruption of the esophagus, due to an increase in esophageal pressure and is associated with high morbidity and mortality. There are cases reported secondary to bowel obstructions such as incarcerated hernias and gallstone ileus. Here, we describe an unusual autopsy case of Boerhaave syndrome, due to bowel obstruction secondary to biliary adenocarcinoma, which has never been reported in the literature. The patient was an 87-year old male presenting with severe chest and epigastric pain. Computed tomography showed fluid-filled esophagus, gastric distention and an ill-defined mass within the liver. Patient underwent esophagogastroduodenoscopy, which revealed esophageal rupture. Patient expired within 20 hours of admission. On autopsy, the decedent was found to have an esophageal perforation and an inferior hepatic mass, which morphologically and immunohistochemically was consistent with a biliary adenocarcinoma.


Assuntos
Adenocarcinoma/patologia , Neoplasias dos Ductos Biliares/patologia , Diferenciação Celular , Perfuração Esofágica/patologia , Doenças do Mediastino/patologia , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico por imagem , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Perfuração Esofágica/complicações , Perfuração Esofágica/diagnóstico por imagem , Evolução Fatal , Humanos , Fígado/patologia , Masculino , Doenças do Mediastino/complicações , Enfisema Mediastínico/complicações , Enfisema Mediastínico/diagnóstico por imagem , Tomografia Computadorizada por Raios X
19.
BMJ Case Rep ; 12(7)2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31278198

RESUMO

A 68-year-old woman presented with haematemesis and chest pain 3 months after a spontaneous oesophageal perforation. The patient rapidly progressed to a state of hypovolaemic shock and after resuscitation was found to have aorto-oesophageal fistula on CT aortogram. The patient was treated with a successful thoracic endovascular aortic repair.


Assuntos
Doenças da Aorta/etiologia , Fístula Artério-Arterial/etiologia , Fístula Esofágica/etiologia , Perfuração Esofágica/complicações , Doenças do Mediastino/complicações , Idoso , Feminino , Humanos
20.
Magy Seb ; 72(2): 47-51, 2019 Jun.
Artigo em Húngaro | MEDLINE | ID: mdl-31216891

RESUMO

The aim of this study is to present the treatment modalities of unusual late esophageal perforations and ruptures. The reason for diagnostic delay was misinterpretation of pleural collection, overlooked sclerotherapy, foreign body extraction, and delayed recognition of the true origin of empyema after pneumonectomy. In all instances of transthoracic reinforced or temporary excluded primary repair were successful. In a 6- week-old iatrogenic perforation with localised empyema, Urschel-Ergin type exclusion with tube thoracostomy and lavage was used. In a 13-day-old rupture, and in a late postpulmonectomy perforation, Johnson type exclusion, decortication, and/or fenestration and second-stage colonic or Roux-en-Y by-pass were carried out. One patient was lost in deep sepsis for a delayed recognised transfixion esophageal injury. It is never too late to attempt to repair and salvage a perforated or ruptured healthy esophagus.


Assuntos
Perfuração Esofágica/etiologia , Esôfago/lesões , Complicações Pós-Operatórias , Ruptura/etiologia , Toracotomia , Diagnóstico Tardio , Empiema/etiologia , Perfuração Esofágica/diagnóstico , Perfuração Esofágica/cirurgia , Esofagectomia , Esôfago/cirurgia , Humanos , Doença Iatrogênica , Ruptura/cirurgia , Técnicas de Sutura , Irrigação Terapêutica , Toracostomia , Fatores de Tempo , Resultado do Tratamento
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