Complex Iatrogenic Esophageal Injuries: An Imaging Spectrum

Madan, Rachna; Bair, Ryan J.; Chick, J.

doi:10.2214/ajr.14.12476

Cited by 17 publications

(11 citation statements)

References 31 publications

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“…After esophagectomy, patients are at increased risk for aspiration because of possible recurrent laryngeal nerve injury. Using a lowosmolar, nonionic, water-soluble contrast agent, keeping the head of the table elevated, closely watching for aspiration throughout the study, and being prepared to suction should aspiration occur will help minimize risk for pulmonary complications from aspiration (36).…”

Section: Anastomotic Leaksmentioning

confidence: 99%

“…If the conduit appears intact with use of a lowosmolar, nonionic, water-soluble contrast agent, the nasogastric tube is removed, and the study is repeated with the patient swallowing thin barium. Use of a water-soluble contrast agent alone can fail to depict small leaks (36,37). Barium has a higher density than water-soluble contrast agents and may adhere more strongly to the site of leakage.…”

Section: Anastomotic Leaksmentioning

confidence: 99%

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Esophagectomy and Gastric Pull-through Procedures: Surgical Techniques, Imaging Features, and Potential Complications

Flanagan¹,

Batz²,

Saboo³

et al. 2016

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Esophagectomy takes the center stage in the curative treatment of local and local-regional esophageal cancer. It is a complex procedure with a high postoperative complication rate. When interpreting imaging studies, radiologists must understand the surgical techniques used and their potential complications. The most common surgical techniques are transthoracic esophagectomies, such as the Ivor Lewis and McKeown techniques, and transhiatal esophagectomy. Variations of these techniques include different choices of conduit (ie, stomach, colon, or jejunum) to serve in lieu of the resected esophagus. Postoperative imaging and accurate interpretation is vital in the aftercare of these patients. Chest radiographs, esophagrams, and computed tomographic images play an essential role in early identification of complications. Pulmonary complications and anastomotic leaks are the leading causes of postoperative morbidity and mortality secondary to esophagectomy. Other complications include technical and functional problems and delayed complications such as anastomotic strictures and disease recurrence. An esophagographic technique is described that is performed by using hand injection of contrast material into an indwelling nasogastric tube. Familiarity with the various types of esophagectomy and an understanding of possible complications are of utmost importance for radiologists and allow them to be key participants in the treatment of patients undergoing these complicated procedures.

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Section: Anastomotic Leaksmentioning

confidence: 99%

Section: Anastomotic Leaksmentioning

confidence: 99%

Esophagectomy and Gastric Pull-through Procedures: Surgical Techniques, Imaging Features, and Potential Complications

Flanagan¹,

Batz²,

Saboo³

et al. 2016

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“…In fact, the drug's instruction label clearly states that it should not be used to treat patients with esophageal tracheal fistulas. Moreover, its rates of sensitivity and specificity in diagnosing esophageal fistulas were only 45.5 and 97.8% ( 11 ), respectively. We actually had more patients who completed treatment than was reported in the previous literature ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…Enhanced spiral computed tomography (CT) can be used to not only observe the integrity of the esophageal wall, but also to clearly observe the surrounding tissues and organs. Additionally, enhanced spiral CT provides for the early detection of small amounts of gas accumulation around the esophagus ( 10 , 11 ); however, it is too expensive and thus unsuitable for routine screening.…”

Section: Introductionmentioning

confidence: 99%

Clinical Application of Oral Meglumine Diatrizoate Esophagogram in Screening for Esophageal Fistula During Radiotherapy or Chemoradiotherapy for Esophageal Cancer

Geng

Zhao

et al. 2020

Front. Oncol.

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Background: This study aimed to investigate the specificity and sensitivity of oral meglumine diatrizoate esophagogram in screening for esophageal fistula during radiotherapy or chemoradiotherapy for esophageal cancer and determine if early detection and intervention could improve the prognosis of esophageal fistulas. Methods: Esophageal cancer patients undergoing radiotherapy or chemoradiotherapy were included. Weekly oral meglumine diatrizoate esophagograms were performed to screen for esophageal fistulas during radiotherapy. When an esophageal fistula was detected, fibroesophagoscopy and computed tomography (CT) were used for confirmation; once confirmed, radiotherapy was discontinued, and the patient received intervention. The esophagogram results were reviewed weekly to assess the recovery of the esophageal fistula. If the fistula was healed, the patient resumed and completed radiotherapy. Results: A total of 206 patients with cancer of the esophagus undergoing chemotherapy/radiotherapy were included. During radiotherapy, 10 cases of esophageal fistula were detected or suspected based on the oral meglumine diatrizoate esophagography findings, and eight of those cases were confirmed by CT and esophagoscopy. All patients with esophageal fistula received intervention; among them, 62.5% (5/8) recovered after 1 to 2 weeks of treatment and continued radiotherapy to completion. The sensitivity and specificity of oral meglumine diatrizoate esophagography in screening for esophageal fistulas during radiotherapy or chemoradiotherapy were 100 and 98.9%, respectively. The median survival period of patients with esophageal fistulas was 6.4 months. Conclusion: Oral meglumine diatrizoate esophagography has high sensitivity and specificity in screening for esophageal fistulas during radiotherapy or chemoradiotherapy with minimal side effects. Early diagnosis and timely intervention can significantly improve the prognosis and prolong the survival period of patients. Trial Registration: Chictr.org.cn, Identifier: ChiCTR-DDD-17012617. Registered on September 7, 2017. The first participant was enrolled on September 25, 2017. http://www.chictr.org.cn/showproj.aspx?proj=21526 .

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“…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%, this is due to the anatomical location of the oesophagus which predisposes to mediastinitis which carries a high mortality [6,7]. Several factors, including the difficulty of accessing the esophagus, the lack of a strong serosal layer, the unusual blood supply of the organ and the proximity of vital structures, all contribute to this condition's high morbidity and mortality [8].…”

Section: Introductionmentioning

confidence: 99%

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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Complex Iatrogenic Esophageal Injuries: An Imaging Spectrum

Cited by 17 publications

References 31 publications

Esophagectomy and Gastric Pull-through Procedures: Surgical Techniques, Imaging Features, and Potential Complications

Esophagectomy and Gastric Pull-through Procedures: Surgical Techniques, Imaging Features, and Potential Complications

Clinical Application of Oral Meglumine Diatrizoate Esophagogram in Screening for Esophageal Fistula During Radiotherapy or Chemoradiotherapy for Esophageal Cancer

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

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