A conservative approach in selected cases of late diagnosed oesophageal perforation.

Abstract

. (1977). Thorax, 32,[232][233][234]. A conservative approach in selected cases of late diagnosed oesophageal perforation. A conservative method is presented for the treatment of oesophageal perforation where the diagnosis has been delayed. A system of tubes is described which allows the patient to be fed and at the same time prevents swallowed material from reaching the fistula. A case is reported which was successfully managed using the method.

Two-stage surgery for delayed esophageal perforation and concomitant chylothorax secondary to upper gastrointestinal endoscopy

“…Nonoperative management includes keeping the patient nil by mouth for 2–3 days, nasogastric tube, broad-spectrum antimicrobial therapy, total parenteral nutrition, and drainage of pleural or mediastinal collection by chest drain or CT guided catheters [ 39 , 40 ]. Although few cases have been reported successfully treated with endoscopically placed coated stents and clipping, their clear role yet needs to be established.…”

Aggressive Surgical Treatment in Late-Diagnosed Esophageal Perforation: A Report of 11 Cases

“…Importantly, the greater the delay in the diagnosis of perforation, the more edematous and necrotic is the esophageal wall. In this circumstance, identification of the esophageal wall can be extremely challenging during dissection and attempt at direct repair frequently fails [ 14 , 16 ]. We used this method in four patients, two with cervical and two with thoracic perforations.…”

“…Although esophageal resection is a major intervention, it is safe and reliable treatment option for complicated perforation of the thoracic esophagus. During the procedure, intrathoracic sepsis can be eliminated confidently, as its source, the leaking esophagus, is removed [ 14 , 16 ]. Primary esophageal resection is indicated in the following circumstances: concurrent obstructive esophageal disease is detected, the injury is relatively extensive and associated with mediastinal or intrapleural sepsis, the viability of the wound edges, principally the mucosa, is in doubt, primary over swing of the perforation would result in at least 50% narrowing of the esophageal lumen, and generalized sepsis has already developed [ 1 , 5 , 9 , 14 , 16 ].…”

“…It seems that the prevalence of esophageal perforation is increasing worldwide because of widespread use of endoscopy for diagnosis and treatment of esophageal diseases [ 5 ]. The importance of early diagnosis and prompt surgical treatment of perforated esophagus cannot be overstated [ 6 ]. Considering the rarity of this condition and its nonspecific presentations, delay in the diagnosis and treatment occurs in more than 50% of cases [ 7 ].…”

A tube system for the management of ruptured oesophagus

“…Previously, we have placed catheters under continuous suction via the nose into the mid-oesophagus and stomach, but have not been satisfied with the presence of tubes in the oropharynx and have found that these suction catheters often block and are difficult t o maintain. Verwoerd et al (6) partly overcame these problems by placing suction catheters in the oesophagus and stomach via a gastrostomy.…”