The influence of the ‘golden 24-h rule’ on the prognosis of oesophageal perforation in the modern era☆

Shaker, Hudhaifah; Elsayed, Hany; Whittle, Ian R.; Hussein, Syed; Shackcloth, Michael

doi:10.1016/j.ejcts.2010.01.030

Cited by 110 publications

(101 citation statements)

References 20 publications

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“…Early diagnosis and management (in the 'golden 24 hours') are reportedly associated with superior outcomes. 1,6 Malignant perforation, sepsis, the need for mechanical ventilation on presentation, and pulmonary co-morbidity are reported to have a significant impact on overall survival. 5 In our cohort, pulmonary co-morbidity, hepatic disease, and malignant perforation were associated with risk of death.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,4,5 Diagnosis and treatment within 24 hours of perforation are critical if favourable outcomes are to be achieved. 1,6 After diagnosis and the initial phase of resuscitation, there is a wide range of treatment options, which are informed by the presentation, aetiology, location of perforation, and the extent of mediastinal or intrathoracic contamination. Surgery remains the mainstay of treatment; the conventional operative approach is considered to be primary repair of the perforation site and drainage.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Outcomes after oesophageal perforation: a retrospective cohort study of patients with different aetiologies

Law

Chan

et al. 2017

Hong Kong Med J

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outcomes after oesophageal perforation: a retrospective cohort study of patients with different aetiologies

Law

Chan

et al. 2017

Hong Kong Med J

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“…In an article by Shaker et al [29], the golden 24 h rule in the early diagnosis and management of esophageal perforation is crucial for successful outcome. In a study by Muir et al [30], the lowest mortality rate was seen in the group of patients who had a cervical perforation (8 %).…”

Section: Discussionmentioning

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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“…[4,5] This intervention allows primary repair and addresses the surrounding contamination, infl ammation, and potential necrosis to a better degree than conservative management or endoscopy. There are a number of surgical approaches available depending on the degree of contamination and extent of the tear.…”

Section: Discussionmentioning

confidence: 99%

When gastroenteritis isn't: a case report of a 20-year-old male with Boerhaave's syndrome complicated by intra-abdomimal hemorrhage

Baird¹,

Norinsky²

2016

World Journal of Emergency Medicine

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Here we present the case of a 20-year-old male with a known history of an artificial mechanical aortic valve replacement at ages four and twelve, on chronic warfarin therapy, who presented to our community emergency department for the evaluation of vomiting, diarrhea, generalized malaise and abdominal pain. He was seen at a local urgent care for similar symptoms earlier in the day, subsequently discharged with a diagnosis of mild gastroenteritis; however, according to the patient's sister, upon his return home he looked very unwell and she called an ambulance immediately. He stated the vomiting was nonbloody, nonbilious and without a coffee-ground appearance; the diarrhea likewise was nonbloody, nonmelenic, but mucousy. He had chills, but denies recent fevers, urinary complaints, back pain, chest pain, cough, or dyspnea. No recent illnesses, sick contacts, or travel. The patient denied any other medical or surgical history. Importantly, the patient reported no recent adjustments in his warfarin dose, admitted compliance, with last INR 2.1 two days prior to presentation.He was immediately brought to an examination room for evaluation (ESI level 1) and upon initial presentation was found to be toxic-appearing. Initial vital signs were as follows: blood pressure 88/52 mmHg, pulse rate 138 beats/minute, breathing 32 respirations/minute, a rectal temperature of 94.2 degrees Fahrenheit, and saturating 91% on ambient air. He was ashen, with sunken eyes and dry mucous membranes. Conjunctivae were pale. Cardiopulmonary exam was significant for tachypnea, tachycardia, and a systolic murmur consistent with his history of aortic valve replacement. Abdomen was soft, nondistended, diffusely tender without particular focal tenderness in any quadrant, and hypoactive bowel sounds, without peritoneal signs of guarding, rebound, or rigidity. Rectal examination revealed no gross or microscopic blood. Peripheral pulses were weak but palpable in the radial and femoral arteries. The remaining physical examination was unremarkable.Given his significant presentation and past medical history, an extensive work-up was immediately undertaken specifically focusing on inflammatory markers, bleeding studies, and imaging of the abdomen. The patient was mentating, had no signs of impending airway or breathing decompensation. Nursing staff was instructed to place two large-bore intravenous lines, with two boluses of warmed normal saline and to cover the patient with a Bair hugger. An emergent bedside ultrasound of the abdomen via RUSH protocol (rapid ultrasound for shock/hypotension) was performed by the emergency physicians, revealing a moderateto-large amount of intra-abdominal free fluid in the splenorenal, hepatorenal, and perivesicular spaces; the inferior vena cava was fully collapsed; the left ventricle was hyperdynamic; there was no evidence of pericardial effusion, abdominal aortic aneurysm or dissection. A bedside chest radiograph revealed no evidence of infi ltrates or pleural effusions, subdiaphragmatic free air, pneumothorax, or any...

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The influence of the ‘golden 24-h rule’ on the prognosis of oesophageal perforation in the modern era☆

Cited by 110 publications

References 20 publications

Outcomes after oesophageal perforation: a retrospective cohort study of patients with different aetiologies

Outcomes after oesophageal perforation: a retrospective cohort study of patients with different aetiologies

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

When gastroenteritis isn't: a case report of a 20-year-old male with Boerhaave's syndrome complicated by intra-abdomimal hemorrhage

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