Selective Nonoperative Management of Contained Intrathoracic Esophageal Disruptions

Cameron, John L.; Kieffer, Richard F.; Hendrix, Thomas R.; Mehigan, Denis G.; Baker, R. Robinson

doi:10.1016/s0003-4975(10)63335-8

Cited by 399 publications

(174 citation statements)

References 8 publications

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“…This therapy involves a total prohibition of oral food intake for a minimum of 7 days, administration of broad spectrum antibiotics and parenteral hyperalimentation [14,[16][17][18][19]20]. In our series, 2 patients received conservative treatment [14][15][16][17][18][19][20]. Broad spectrum antibiotic therapy, prohibition of oral food intake for 5 days and parenteral hyperalimentation were applied in these cases [15].…”

Section: Discussionmentioning

confidence: 99%

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The Success of Surgery in the First 24 Hours in Patients with Esophageal Perforation

Bayram

Erol

Melek

et al. 2015

EAJM

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Objective: Esophageal perforation (EP) is a critical and potentially life-threatening condition with considerable rates of morbidity and mortality. Despite many advances in thoracic surgery, the management of patients with EP is still controversial. Materials and Methods:We retrospectively reviewed 34 patients treated for EP, 62% male, mean age 53.9 years. Sixty-two percent of the EPs were iatrogenic. Spontaneous and traumatic EP rates were 26% and 6%, respectively. Three patients had EP in the cervical esophagus and 31 in the thoracic esophagus.Results: Mean time to initial treatment was 34.2 hours. Twenty patients comprised the early group <24 h) and 14 patients the late group (>24 h). Management of the EP included primary closure in 30 patients, non-surgical treatment in two, stent in one and resection in one. Mortality occurred in nine of the 34 patients (26%). Mortality was EP-related in four patients. Three of the nine patients that died were in the early group (p<0.05). Mean hospital stay was 13.4 days. Conclusion:EP remains a potentially fatal condition and requires early diagnosis and accurate treatment to prevent the morbidity and mortality. Keywords: Esophageal perforation, emergency treatment, thoracic surgery ÖzetAmaç: Özofagus perforasyonları (ÖP) kritik , hayatı tehdit eden mortalite ve morbidite riski yüksek olgulardır. Göğüs Cerrahisi'ndeki tüm gelişmelere rağmen bu olgulara yaklaşım günümüzde de tartışmalıdır. Gereç ve Yöntem:ÖP nedeniyle tedavi ettiğimiz 34 hastayı retrospektif olarak değerlendirdik. Erkek hastalar tüm hastaların %62' sini oluşturmaktaydı. Ortalama yaş: 53,9 olarak saptandı. Tüm perforasyonların %62' si iatrojenik nedenlerden kaynaklanmaktaydı. Spontan ve travmatik perforasyon oranları sırasıyla %26 ve % 6 olarak hesaplandı. 3 Hastada boyunda, 31 hastada ise torasik özofagusda perforasyon saptandı. Bulgular:Tedavinin ortalama başlama süresi 34, 2 saatti. 20 hasta erken grup içindeydi (<24 saat), 14 hasta ise geç grup (>24 saat) olarak sınıflandırıldı. Cerrahi olarak; 30 hastada primer onarım,1 hastada özofagus rezeksiyon ve anastamoz, 1 hastada stent ve 2 hastada medikal tedavi uygulandı. Mortalite 9 hastada gelişti %26. Mortalite nedeni 4 hastada ÖP'a sekonderdi. 9 Hastanın 3' ü erken tedavi grubundaydı (p<0,05). Ortalama hastanede yatış süresi 13,4 gündü. Sonuç: ÖP potansiyel ölümcül sonuçlar doğurabileceğinden morbidite ve mortaliteyi azaltmak için erken tanı ve etkili tedavi gereklidir. Anahtar Kelimeler: Özofagus perforasyonu, acil tedavi, göğüs cerrahisiCorrespondence to: M. Muharrem Erol,

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Section: Discussionmentioning

confidence: 99%

“…In our series, 2 patients received conservative treatment [14][15][16][17][18][19][20]. Broad spectrum antibiotic therapy, prohibition of oral food intake for 5 days and parenteral hyperalimentation were applied in these cases [15]. Patients were monitored using contrast CT on the 5 th day and discharged on the 6 th day.…”

Section: Discussionmentioning

confidence: 99%

The Success of Surgery in the First 24 Hours in Patients with Esophageal Perforation

Bayram

Erol

Melek

et al. 2015

EAJM

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“…Is free air increasing or decreasing on consecutive X-ray, and does symptoms aggravate during close observation? Traditionally, duodenal perforations have been managed surgically 19 ; however, in the past decade, management of limited esophageal, colonic, and even duodenal perforations has evolved toward a more selective approach. 7,20,21 The surgical procedure was selected, based on mechanism and degree of injury.…”

Section: Discussionmentioning

confidence: 99%

Management of ERCP-Related Perforations: Outcomes of Single Institution in Korea

Kim

Yoo

Kim

et al. 2009

Journal of Gastrointestinal Surgery

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Introduction The aim of this study was to analyze clinicoradiologic findings and treatment outcomes of patients with endoscopic retrograde cholangiopancreatography (ERCP)-related perforations. Between May 2003 and November 2007, 2,247 ERCP procedures with or without sphincterotomy were performed at Ajou University Medical Center, Suwon, Korea, and 20 perforations (0.89%) were identified. Discussion We retrospectively reviewed medical and surgical records of each patient. Of 18 patients, 11 patients (61.1%) underwent nonsurgical management, and seven patients (38.9%) received surgical management. There were no significant differences in age, gender, and laboratory findings between two groups (P>0.05). The hospital stay was significantly longer in the operative group than that of the conservative group (P<0.05, respectively). The most common cause of perforation was sphincterotomy (n=8) in the conservative group whereas scope itself (n=6) in operative group, showing a significant difference between the two groups (P<0.05). The retroperitoneal air was most common findings in eight patients (72.7%) of the conservative group, while six (85.7%) patients of the operative group presented with intraperitoneal air, displaying a significant difference in location of air between the two groups (P<0.05). Most of sphincterotomy-related perforations were managed nonsurgically. However, the scope-related perforations were usually large and required immediate surgery. Moreover, the delayed operation resulted in a longer hospital stay and high morbidity. Therefore, the selective early surgical intervention is suggested when scope-related perforations are discovered.

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“…In the present series, use of CT scan with oral contrast resulted in early diagnosis and intervention leading to a mortality as low as 9%. Non-operative management was used in 14 patients who met the criteria of Cameron [11] and Altorjay [2]. Recent, contained perforations in stable patients with minimal signs and symptoms were subjected to non-operative treatment.…”

Section: Discussionmentioning

confidence: 99%

Management of post dilatation oesophageal perforation: an experience from a tertiary centre

et al. 2008

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Selective Nonoperative Management of Contained Intrathoracic Esophageal Disruptions

Cited by 399 publications

References 8 publications

The Success of Surgery in the First 24 Hours in Patients with Esophageal Perforation

The Success of Surgery in the First 24 Hours in Patients with Esophageal Perforation

Management of ERCP-Related Perforations: Outcomes of Single Institution in Korea

Management of post dilatation oesophageal perforation: an experience from a tertiary centre

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