‘Spontaneous’ rupture of the healthy oesophagus

Toghill, P J; MacGuire, C. F.; Raut, P

doi:10.1136/pgmj.44.513.504

Cited by 11 publications

(2 citation statements)

References 19 publications

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“…The 'V' sign of Naclerio, a triangular lucency seen through the heart which has been associated with lower esophageal perforation, has been variously ascribed to emphysema in the triangular ligament, as well as to chemical mediastinitis [5,10]. In addition, pneumoperitoneum may be seen.…”

Section: Radiographic Manifestations Of Esophageal Injurymentioning

confidence: 99%

Trauma to the esophagus

Love

Berkow

1977

Gastrointest Radiol

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We have classified.esophageal trauma into three major categories: (1) Iatrogenic trauma including endoscopic perforation, trauma due to dilatation, surgical trauma, tube trauma, radiation trauma, and drug trauma; (2) Self-induced trauma including foreign bodies, corrosive or drug ingestion, and postemetic trauma; (3) Direct trauma including penetrating trauma and blunt trauma. Discussion and illustrative cases are presented.

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Section: Radiographic Manifestations Of Esophageal Injurymentioning

confidence: 99%

Trauma to the esophagus

Love

Berkow

1977

Gastrointest Radiol

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“…Prior to 1946 there had been no record of successful treatment (Barrett 1946) but since then there have been several (Barrett 1947, Borrie 1955); 90% of the cases occur in males (Borrie 1958) and the tear is said to occur nearly always in the relatively unsupported, lower third of the cesophagus (Mallory & Weiss 1929) on the left side (Mackler 1952). However, on reviewing a total of 15 cases described by various authors (Barrett 1946, 1947, Mackler 1952, Nanson & Walker 1953, Borrie 1958, Toghill et al 1968), the site of the rupture in 9 cases was on the left side and in 6 cases on the right side. This is a much higher incidence of right-sided rupture than was previously thought and although the numbers are small, this indicates the need for a full survey of the literature and for an awareness that right-sided rupture may be only slightly less common than left-sided rupture.…”

Section: Commentmentioning

confidence: 99%

Spontaneous Rupture of the Œsophagus

Drinkwater

1969

Proceedings of the Royal Society of Medicine

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“Spontaneous” perforation of the oesophagus treated by utilization of a pericardial flap

Millard

1971

Journal of British Surgery

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SUMMARYA case of 'recurrent' spontaneous perforation of the oesophagus treated by the utilization of a pericardial flap is reported. It is suggested that this manaeuvre, which does not appear to have been described previously, may be life-saving when there has been delay in operating or major secondary leakage has occurred. THE purpose of this report is to record the successful management of a case of spontaneous perforation of the oesophagus using a flap of pericardium to reinforce the repair after there had been further gross leakage following a conventional closure of the tear.This does not appear to have been attempted previously.FlG. I.-Radiograph of chest and abdomen revealing elevation of the left diaphragm hut no free gas. CASE REPORTH. J., a man of 37, was admitted at 1.30 a.m. on 28 Sept., 1969, having collapsed with severe upper abdominal pain whilst vomiting after a big meal with much alcohol.On examination he was found to be hypotensive, cold, and cyanosed with marked upper abdominal tenderness and rigidity; radiographs of the chest and abdomen revealed a little elevation of the left diaphragm but no free gas (Fig. I). The white blood-count was 17,000; serum amylase, 29 I.U.; and E.C.G., normal. A provisional diagnosis of a perforated peptic ulcer was made and at 3.30 a.m. a laparotomy was performed but no abnormality found. By 6.0 p.m. signs of fluid and air had appeared in the left chest associated with respiratory distress (Fig. z), thus revealing the diagnosis of a perforated oesophagus. As the general condition of the patient precluded further immediate operation, an intercostal drain was inserted and supportive treatment given. By 10 a.m. the following day (29 September) sufficient improvement had occurred to permit a left thoracotomy (A. H. M.), when a longitudinal tear of approximately 7 cm. was found on the left lateral aspect of the lower oesophagus associated with a gross contamination of the pleural cavity with food debris and beer. Although oedematous, the tear was easily repaired with a series of interrupted 'all-layer' silk sutures and, after pleural toilet, the chest was closed with apical and basal valved drains. Improvement was immediate and maintained until 4 October, when fluid again began to appear in the left chest, culminating, on 6 October, in a frank aeropleural fistula, indicating that a major oesophageal leakage had recurred. The chest was reopened and a gross empyema secondary to complete disruption of the repair found, all the sutures having 'cut through'.The oesophagus was now so oedematous and friable that any attempt at resuture appeared foredoomed to failure and further leakage inevitable. The loosely sutured oesophagus was therefore reinforced by turning down a large flap from the adjacent pericardium and carefully suturing it to the mediastinal pleura along its posterior, superior, and inferior margins (Fig. 3); pleural toilet was again carried out and the chest closed with valved drainage as before but, in addition, a gastrostomy was established. Further progress w...

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‘Spontaneous’ rupture of the healthy oesophagus

Abstract: Summary The clinical features of four cases of ‘spontaneous’ rupture of the oesophagus are described together with the radiological changes. It is emphasized that the diagnosis often may be made from simple penetrated views of the heart shadow with the patient in the erect position.

Cited by 11 publications

References 19 publications

Trauma to the esophagus

Trauma to the esophagus

Spontaneous Rupture of the Œsophagus

“Spontaneous” perforation of the oesophagus treated by utilization of a pericardial flap

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