Surgical and Conservative Management of Esophageal Perforation

Keszler, P; Buznă, E

doi:10.1378/chest.80.2.158

Cited by 37 publications

(13 citation statements)

References 13 publications

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“…While some authors advocate mandatory exploration of all penetrating wounds to the cervical oesophagus, 2,16,[18][19][20] others favour a selective approach, exploring only those patients with symptoms, signs or investigative evidence of injury to the trachea and oesophagus. 6,9,10,17,21 Proponents of the mandatory approach argue that clinical and radiological assessment is unreliable and that major, potentially fatal, injuries may be missed. Those employing the selective policy cite the high incidence of negative exploration with its attendant morbidity if routine exploration is employed.…”

Section: Discussionmentioning

confidence: 99%

“…Delay increases morbidity and mortality and attempting repair in these patients is unlikely to succeed; 17 these patients should ideally undergo debridement and drainage without attempted repair. 2,7,9,17,21 Although some authors use double-layer repair, 1,8,22 other studies have shown that repair with a single layer is safe and effective both in traumatic 16,23 and non-traumatic situations. 24,25 Our policy is to use a single layer suture.…”

Section: Discussionmentioning

confidence: 99%

“…Further management of these patients, irrespective of initial treatment, consists of a course of antibiotics, nothing-by-mouth, and surgical nutrition, 9,21 In contrast to some authors 1,21 who suggest the use of total parenteral nutrition (TPN), we advocate the use of enteral nutrition through a fine-bore feeding tube, as it is convenient, simple, safe and effective and avoids the complications related to TPN. 2,29 The length of time required for closure is variable and has been reported between 5 days and 3 weeks.…”

Section: Discussionmentioning

confidence: 99%

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Penetrating injuries to the cervical oesophagus: is routine exploration mandatory?

Madiba

Muckart²

2003

Annals of the Royal College of Surgeons of England

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Background: There are differing views regarding the management of oesophageal injuries with some authors advocating mandatory operation while others prefer a selective, conservative approach. This study was undertaken to establish whether conservative management of cervical oesophageal injuries is safe and effective. Patients and Methods: This is a retrospective study carried out over 5 years (1994)(1995)(1996)(1997)(1998). Of 1358 patients with neck trauma, 220 presented with odynophagia, of whom 28 were shown on contrast swallow to have cervical oesophageal injury (17 stabs, 11 firearms). Median age was 26 years (range, 11-44 years). There were 23 males (M:F ratio, 6:1). All patients with contained extravasation were managed non-operatively irrespective of the delay from injury to admission. Repair was undertaken in patients with major disruption and those requiring exploration for another reason. Associated tracheal injuries were repaired primarily with or without tracheostomy. Patients were fed using fine bore enteral feeding tubes. Oral feeding was recommenced after a water soluble contrast swallow had confirmed healing. Results: All patients presented with odynophagia. Seven had clinical surgical emphysema, and 15 had retropharyngeal air on lateral neck X-ray. Chest X-ray showed surgical emphysema in 8, haemothorax in 2 and pneumothorax in 2. Seventeen patients were managed non-operatively. Sixteen recovered with no complications, while one developed local sepsis. Eleven patients underwent exploration (debridement in 7 and primary repair in 4). There were 6 associated tracheal injuries, all of whom underwent primary repair with tracheostomy performed in four. Thirteen patients were admitted to the intensive care unit. Median duration of enteral tube feeding was 18 days (range, 5-40 days) and median hospital stay was 18 days (range, 6-91 days). Two patients with firearm injuries died from associated injuries. Conclusion: Non-operative management of penetrating injuries to the cervical oesophagus is safe and effective.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Penetrating injuries to the cervical oesophagus: is routine exploration mandatory?

Madiba

Muckart²

2003

Annals of the Royal College of Surgeons of England

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“…In addition, large blood vessels, such as the aorta, may rupture at any time due to corrosion by pus, particularly when fistulae is confined to the superior mediastinum. Moreover, the rarity, occultness, and difficult exposure of this condition often delay its diagnosis, by which time the affected esophageal wall may have become edematous and friable, and fibrinous mediastinitis may have developed, making primary surgical repair almost impossible[13]–[15]. Thus, despite the recently reported muscle onlay approach, which yielded satisfactory results[16], we preferred using more conservative interventional therapy.…”

Section: Discussionmentioning

confidence: 99%

Managing esophageal leaks by endoscopic transluminal drainage in esophageal cancer patients with superior mediastinal sepsis after esophagectomy

Zheng¹,

Dai

Shan³

et al. 2012

Chin J Cancer

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The management of postoperative leaks into the mediastinum after esophagectomy remains a challenge. We describe our clinical management of this complication through endoscopic transluminal drainage. Between 2008 and 2011, 4 patients with esophageal squamous cell carcinoma (ESCC) who underwent McKeown-type esophagectomy with two-field lymphadenectomy experienced complicated anastomotic fistulae in the presence of superior mediastinal sepsis. All 4 patients underwent endoscopic transluminal drainage, and all survived. The mean healing period was 50 days (range, 31 to 58 days), the mean stay in the intensive care unit was 7.3 days (range, 1 to 18 days), and the mean hospital stay was 64.5 days (range, 49 to 70 days). Endoscopically guided transluminal drainage should be considered for ESCC patients with superior mediastinal fistulae after esophagectomy.

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“…The causes of iatrogenic esophageal perforation include endoscopic procedures, nasogastric tube insertion, difficult endotracheal intubation, percutaneous tracheostomy, surgery of the mediastinal organs including resection of lung cancer, operations on the cervical spine, thyroidectomy, and palliative intubation, stenting, or laser treatment of esophageal tumors [5,6]. Foreign body ingestion, penetrating trauma, and corrosive injury are other causes of perforations [1].…”

Section: Introductionmentioning

confidence: 99%

Cervical Esophageal Perforation: A 10-Year Clinical Experience in North of Iran

Aghajanzadeh

Porkar

Ebrahimi

2014

Indian J Otolaryngol Head Neck Surg

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Perforations of the cervical esophagus are infrequent severe conditions associated with a high rate of morbidity and mortality if misdiagnosed. The diagnosis and management of cervical esophageal perforation remains a challenging clinical problem. We aimed to present our experience of the etiology, presentation, management and outcome of cervical esophageal perforation in a 10 years period. In this cross-sectional study, we reviewed the records of all patients with a diagnosis of cervical esophageal perforation admitted at the teaching Razi Hospital of Rasht, north of Iran, between 2001 and 2011. 26 patients (15 male) were studied with mean age of 47.6 ± 13.78 years, a range from 10 to 68 years. Only 16 (61.5 %) of patients were referred within 24 h of injury. The etiology was iatrogenic in 15 cases (57.69 %), foreign body ingestion in 7 cases (26.9 %), and penetrating traumatic injury in 4 cases (15.4 %). The common clinical manifestations of perforation were neck pain in 22 cases (84.6 %), fever in 19 cases (73.1 %), and subcutaneous emphysema in 12 cases (46.2 %). Barium and gastrografin swallow were performed in 57.7 and 23.1 % of patients, respectively and flexible esophagoscopy was used in 23.06 %. Most of patients (65.4 %) were managed by primary repair. Overall, mortality rate was 7.7 %. Our study demonstrates that the most common cause of cervical esophageal perforation is iatrogenic injury. Clinical suspicion is most important problem. Furthermore, Diagnosis is mainly made by Barium and gastrografin swallow. For a successful outcome, primary repair is a preferred treatment for most perforation patients.

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Surgical and Conservative Management of Esophageal Perforation

Cited by 37 publications

References 13 publications

Penetrating injuries to the cervical oesophagus: is routine exploration mandatory?

Penetrating injuries to the cervical oesophagus: is routine exploration mandatory?

Managing esophageal leaks by endoscopic transluminal drainage in esophageal cancer patients with superior mediastinal sepsis after esophagectomy

Cervical Esophageal Perforation: A 10-Year Clinical Experience in North of Iran

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