Cervical Esophageal Perforation and Cricopharyngeal Dysfunction

Helton, W. Brian; Unnikrishnan, Raman; Gal, Thomas J.

doi:10.1177/014556131109000315

Cited by 2 publications

(4 citation statements)

References 9 publications

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“…In the mid-20th century, successful primary repair of esophageal perforation was first reported by Barrett in 1946 and later by Olsen and Claggett in 1947, and esophagectomy for esophageal perforation was described by Satinski and Kron in 1952, all of which led the way to the modern treatment of these injuries [7,12].…”

Section: Discussionmentioning

confidence: 99%

“…Endotherapy can help avoid surgery in other cases: small tears from endoscopic insertion can be clipped and esophageal fistulae can be injected with fibrin glue. Larger perforations can be treated with stent placement if the dehiscence of the lumen circumference does not exceed 70% [11,12]. Perforation of the intra-abdominal portion of the esophagus often results in a rapid development of peritonitis and sepsis and surgery is usually recommended.…”

Section: Discussionmentioning

confidence: 99%

“…In very ill patients, esophageal exclusion surgery can be carried out until the patient's general condition stabilizes. In cases of a diseased esophagus such as corrosive injury related perforations or cancer of the esophagus, esophageal replacement surgery should be contemplated with total esophagectomy and gastric pull-up surgery or creation of a neoesophagus with colonic interposition [12,13].…”

Section: Discussionmentioning

confidence: 99%

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Iatrogenic Esophageal Rupture during Intragastric Balloon Insertion: A Case Report and Review of Literature

Alassal¹,

Elgazzar²,

Saffan³

et al. 2017

AJCTS

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Iatrogenic esophageal traumas are the most common of esophageal perforation, accounting for up to 60% of cases from which endoscopic perforations are about 70%. Despite modern surgical advanced techniques, perforation of the esophagus still represents a true surgical emergency and this condition is associated with a mortality of 20-30%. Early and accurate diagnosis and treatment of esophageal injuries are critical. Indirect signs of esophageal injury can be seen on a posteroanterior and lateral plain chest X-ray. Such signs include pleural effusion, pneumomediastinum, subcutaneous emphysema, hydrothorax, pneumothorax and collapse of the lung. Computer Tomography (CT) of the chest and upper abdomen with oral contrast can also show a leak and confirm the chest X-ray findings. Three approaches are available for the treatment of esophageal perforation: conservative, endotherapy, and surgery. Surgery is mandatory in any part of the esophagus when the perforation is large or when patients do not improve with conservative or endoscopic treatment. We present our case who survived a massive thoracic esophageal tear during endoscopic intragstric balloon insertion. Emergency right thoracotomy was done; we found an inflated gastric balloon perforating the thoracic esophagus and protruding in the right thoracic cavity with a big longitudinal esophageal tear. The tear was primarily repaired with suture of perforation with reinforcement flaps. We conclude that; iatrogenic traumatic injuries of the esophagus is rare but could be life threatening and must be managed by multiple disciplinary teams. Urgent surgical esophageal repair is the treatment of choice in big thoracic esophageal tears. This is the 1st case documented with esophageal rupture due to intragastric balloon insertion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Iatrogenic Esophageal Rupture during Intragastric Balloon Insertion: A Case Report and Review of Literature

Alassal¹,

Elgazzar²,

Saffan³

et al. 2017

AJCTS

View full text Add to dashboard Cite

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“…Esophageal perforation (EP) is a therapeutic challenge because of its lethality. More than half of the perforations are iatrogenic, and most cases occur during endoscopy (1)(2)(3)(4)(5)(6). Other causes include spontaneous rupture (Boerhaave's syndrome), foreign body ingestion, trauma, and intraoperative injury.…”

Section: Introductionmentioning

confidence: 99%

Esophageal perforation during neoadjuvant chemoradiotherapy for esophageal cancer following transcatheter arterial embolization: a case report

Lu¹,

Wang²,

Chen³

et al. 2021

Ther Radiol Oncol

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Esophageal perforation (EP) is a rare disease mostly caused by iatrogenic endoscopic procedures.Esophageal cancer accounts for ten percent of them, and EP under such circumstance could be more complicated and often leads to poor outcome. Therefore, early recognition is of vital importance to prolong survival. To our knowledge, this is the first case report to propose the possible role of transcatheter arterial embolization (TAE) in EP. A 58-year-old female with stage III esophageal cancer (cT3N1M0) was presented to our emergency room. Four months before, she had received TAE because of tumor bleeding and then underwent neoadjuvant concurrent chemoradiotherapy (CRT) after recovery. Prior completion of CRT, dizziness, vomiting, chest tightness and chest pain developed. On examination, fever up to 38.8 degrees was found, accompanied with increased infiltration over the bilateral lungs on the chest radiograph. Under the initial impression of pneumonia, she was first managed with antibiotics and fluid hydration. However, drop of blood pressure occurred six hours later and emergent computed tomography of chest revealed pneumomediastinum and pericardial effusion. Upper gastrointestinal endoscopy showed severe mucosal breakage and EP was confirmed. Broad-spectrum antibiotics and fluid resuscitation were subsequently initiated. Pericardial window was also performed due to cardiac tamponade and the bacterial culture from the mediastinal fluid yielded Pseudomonas aeruginosa. Placement of metal stent was advised but refused by her family. With supportive care only, the patient died one month later due to progressive sepsis and multiorgan failure. EP may occur during CRT if there are risk factors such as T4 primary tumor, age more than 60 or extracapsular lymph node that involves the esophagus. In our case, we thought previous TAE is another factor that possibly contribute to the EP via generation of ischemia and alteration of healing microenvironment. In this setting, risk of EP should be carefully evaluated when subsequent CRT is attempted.

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Cervical Esophageal Perforation and Cricopharyngeal Dysfunction

Cited by 2 publications

References 9 publications

Iatrogenic Esophageal Rupture during Intragastric Balloon Insertion: A Case Report and Review of Literature

Iatrogenic Esophageal Rupture during Intragastric Balloon Insertion: A Case Report and Review of Literature

Esophageal perforation during neoadjuvant chemoradiotherapy for esophageal cancer following transcatheter arterial embolization: a case report

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