Subphrenic Extrathoracic Rupture of the Esophagus

Strauch, Gerald O.; Lynch, Robert E.

doi:10.1097/00000658-196502000-00008

Cited by 15 publications

(1 citation statement)

References 7 publications

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“…It is generally regarded that at this point the oesophagus is intrinsically weak and has least support from surrounding tissues. This view is reinforced by the fact that while there has been only one reported case of spontaneous rupture of the abdominal oesophagus (Strauch and Lynch, 1965) there are well over 100 involving the lower thoracic oesophagus (Tesler and Eisenberg, 1963).…”

Section: Oesophageal Disruptionmentioning

confidence: 99%

Abdominal approach for the ligation of bleeding oesophageal varices

Miller

1975

Journal of British Surgery

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The conventional surgical treatment of bleeding oesophageal varices in the emergency situation is based upon the Boerema-Crile operation of transthoracic oesophagotomy and ligation of the varices. This and the other methods of treatment of this condition in current practice are discussed. Two cases are reported in which a transabdominal oesophagogastrotomy was used to approach the site of bleeding. This operation is described and the theoretical and practical advantages it appears to offer over the standard approach are considered.

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Section: Oesophageal Disruptionmentioning

confidence: 99%

Abdominal approach for the ligation of bleeding oesophageal varices

Miller

1975

Journal of British Surgery

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Does the Retrocecal Position of the Vermiform Appendix Alter the Clinical Course of Acute Appendicitis?

et al. 1991

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Ninety-four adult patients undergoing appendectomy for acute appendicitis were prospectively studied during a 2-year period. Patients were divided into retrocecal (group 1; n = 27 [29%]) and anterior (group 2; n = 67 [71%]) groups according to the position of the appendix. There was no statistical difference between the two groups in duration of symptoms, presenting signs and symptoms, and initial white blood cell count. Furthermore, retrocecal appendicitis was not associated with a higher rate of perforation or increased morbidity. We conclude that the retrocecal position of the appendix does not alter the presentation of appendicitis.

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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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Subphrenic Extrathoracic Rupture of the Esophagus

Cited by 15 publications

References 7 publications

Abdominal approach for the ligation of bleeding oesophageal varices

Abdominal approach for the ligation of bleeding oesophageal varices

Does the Retrocecal Position of the Vermiform Appendix Alter the Clinical Course of Acute Appendicitis?

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

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