جستجوی مقالات مرتبط با کلیدواژه "esophageal perforation" در نشریات گروه "پزشکی"
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زمینه و هدف
پارگی مری یکی از موارد تهدیدکننده زندگی و جزء اورژانس‌های جراحی می‌باشد. تشخیص دیرهنگام باعث افزایش چشمگیر مرگ‌و‌میر می‌شود، بنابراین نیازمند تشخیص به موقع و درمان مناسب می‌باشد. اما به علت شباهت به سایر بیماری ها، تشخیص سخت مانده و با وجود مطالعات بسیار اتفاق نظر در انتخاب درمان وجود ندارد. هدف از این مطالعه، ارزیابی بیماران دچار پارگی مری مراجعه‌کننده به بیمارستان‌های تابعه شهرستان بابل (بیمارستان‌های آیت‌اله روحانی و شهید بهشتی) از لحاظ عوامل بالینی، نوع درمان و عوارض آن در طی سالهای 1394-1381 می‌باشد.
مواد و روشهادر این مطالعه توصیفی - مقطعی تمام بیماران دچار پارگی مری که در بیمارستان‌های تابعه شهرستان بابل از سال 1394-1381 بستری شده اند، مورد بررسی قرار گرفتند. معیار ورود به این مطالعه تمامی بیماران دچار پارگی مری به دلایل مختلف می-باشند. معیار خروج عدم دسترسی به پرونده بیماران می باشد. تشخیص براساس شرح حال، سابقه پزشکی، مطالعات بالینی و اطلاعات پاراکلینیک شامل رادیولوژی می‌باشد. پرونده بیماران از بایگانی بیمارستان استخراج شده و اطلاعات بیماران در قالب فرم چک لیست وارد شد. اطلاعات در نرم افزار 16V SPSS با آزمون های آماری تی تست و کای دو مورد تجزیه و تحلیل قرار گرفت.
یافتههااز 1381 تا 1394، 27 بیمار با پارگی مری وارد مطالعه شدند که 17 نفر 63% بیماران با تاخیر 24 ساعت درمان شدند. بیشترین علت پارگی جسم خارجی 18 مورد 7/66% و سپس ایاتروژنیک 4 مورد 8/14% و بیشترین علامت بدو مراجعه درد قفسه سینه 14 مورد 9/51% و دیسفاژی 13 مورد 1/48% و بیشترین درمان انتخابی اول در 11 مورد 7/40% ترمیم اولیه و سپس کانسرواتیو 10 مورد 37% بود. تنها یک مورد مرگ و میر 7/3% وجود داشت که بیمار 10 روز بعد از شروع علایم مراجعه کرده بود و دچار عارضه فیستول آیورتوازوفاژیال شده بود.
نتیجهگیریدر این مطالعه علت اصلی مرگ و میر، عارضه پارگی مری به علت تاخیر در درمان مراجعه دیرهنگام بیماران بوده و انتخاب درمان مناسب با توجه به شرایط بیمار (فاصله بین شروع علایم و زمان مراجعه، محل پارگی، علت پارگی علایم بالینی بیماران وپاتولوژی زمینه ای مری) بوده است.
کلید واژگان: پارگی مری, تشخیص به موقع, درمان کانسرواتیو, ترمیم اولیهIntroduction & ObjectiveEsophageal perforation is a life threatening condition, which is considered as a surgical emergency. Delayed diagnosis can cause a significant increase in mortality. Therefore, it requires early diagnosis and appropriate treatment but due to the similarity to other diseases, diagnosis remains difficult and despite the many studies, treatment is still controversial. The Purpose of this study is Evaluation of patients with esophageal perforation concerning clinical factors, treatment and complications in Babol hospitals during years 2002-2015.
Materials & MethodsIn this descriptive cross-sectional study, all patients with esophageal rupture who have been hospitalized in the affiliated hospitals of Babol city from 2002-2015 were studied. Inclusion criteria in this study are all patients with esophageal rupture for various reasons. Exclusion criteria are lack of access to patients' files. Diagnosis is based on medical history, clinical studies, and paraclinical information, including radiology. Patients' files were extracted from the hospital archives and patient information was entered in the form of a checklist. Data were analyzed by SPSS software version 16 by T-Test and chi-square tests.
ResultsFrom 2002 to 2015, 63% of 27 patients with esophageal perforation has been treated late (>24 hours). The predominant etiology was foreign body 18cases 66.7% followed by iatrogenic 4 cases 14.8%, and in 74% the localization was thoracic, in 14 cases 51.9% and 13 cases 48.1% clinical symptoms were chest pain and disphagia at the time of admittion. In 11cases 40.7% and 10cases 37% primary repair and conservative therapy, respectively, was considered the first choice. There was only one death 3.7% in a Patient who had referred 10 days after the onset of symptoms with aortoesophageal fistula.
ConclusionsIn this study, the main cause of mortality was esophageal rupture due to delayed treatment of patients and the choice of appropriate treatment according to the patient's condition (interval between onset of symptoms and time of referral, location of rupture, cause of rupture of clinical symptoms and underlying pathology Mary) has been.
Keywords: Esophageal Perforation, Early Diagnosis, Conservative Therapy, Primary Repair -
Introduction
The possibility of foreign body ingestion should be considered in psychiatricpatients.In some complicated cases, foreign bodies become problematic and require immediate surgical intervention.
Case presentationA 45-year-old man with schizophrenia swallowed razor blades and pieces of glass resulting in esophageal perforation, pneumothorax, pneumomediastinum and urgent need for surgery. He was presented in shock state but successfully passed post-operative period in the intensive care unit and surgical ward and was ultimately transferred to the psychiatric ward.
ConclusionManagement of asymptomatic patients depends on the demographic factors of patients as well as the site affected in the gastrointestinal tract.
Keywords: Esophageal Perforation, Foreign Bodies, Mental Disorders -
Extraction of chicken bone swallowing 10th day after ingestion with penetrating the esophageal wallsA 23-year-old male referred with a history of chicken bone swallowing a week ago (Figure 1). Endoscopy was performed at our center and a chicken bone was found penetrating the esophageal walls (Figure 2). The patient was managed successfully using flexible endoscopy and the chicken bone was removed.Keywords: Foreign Bodies, Esophageal perforation, Endoscopy, Treatment
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Boerhaave syndrome (BS) is a spontaneous esophageal perforation and is a life-threating but uncommon disorder. This syndrome involves a transmural perforation and typically occurs after forceful emesis. The prognosis is dependent on rapid diagnosis and correct management. The classic presentation of BS consists of vomiting, subcutaneous emphysema, and lower thoracic pain. However, significant symptoms and signs rarely occur, about one-third of all patients are clinically atypical. Thus, BS should be suspected in patients presenting any sudden thoracoabdominal pain with a history of emesis. The chest radiograph is the most helpful diagnostic aid, in addition to CT scans for further evaluations.When the clinical condition allows for a less invasive approach, non-operative treatment should be considered, with or without the use of an endoscopic stent or placement of internal or external drains. The best prognosis of Boerhaave's syndrome is associated with early diagnosis and surgical care within 12 hours of perforation.Keywords: Boerhaave's Syndrome, Esophageal perforation, Early Diagnosis
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Two patients with iatrogenic esophageal perforation following rigid esophagoscopy for foreign body removal were successfully treated with primary repair and reinforcement using a collagen patch coated with human fibrinogen and thrombin (TachoSil, Nycomed, Austria, Vienna). The clinical implication of this report is that TachoSil can be used to bolster the repair site of esophageal perforation.Keywords: Esophageal perforation, Treatment, Closure
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Esophageal perforation is a rupture of the esophageal wall, caused by iatrogenesis in 56% of cases. Perforation of the esophagus remains a challenge, and its incidence has increased as the use of endoscopic procedures has become more frequent. We report a 54-year-old woman with esophageal perforation 8 days after kidney transplantation. She had received a gastrointestinal consultation prior to her transplantation. This report highlights the fact that perforation may occur after any organ transplantation, especially during the initial 2 weeks after transplantation, when mycophenolate mofetil and cyclosporine as well as and high doses of corticosteroid are administered. If there is a delay in passage and a swallowing difficulty, high doses of immunosuppressive drugs are likely to cause ulceration and perforation. Preventive strategies including intravenous steroids for the first 2 to 3 weeks and divided doses of pills should be considered for such patients.Keywords: Complications, gastrointestinal tract, esophageal perforation, kidney transplantation
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Herein, we present the case of a 45-years-old woman with a foreign body (dental prosthesis) ingestion lodged in the esophagus(Figure.1). The foreign body was extracted by rigid esophagoscopy after severe manipulation. In 24 hours, the patient became febrile with emphysema in the neck. laboratory data showed leukocytosis and CT scan revealed signs of esophageal perforation(Figure.2). Surgical exploration and drainage of the neck and mediastinum performed through a collar incision in the neck extended to the anterior of SCM in both sides, but we didnt perform feeding jejunostomy. We inserted one corrugated drain in every side of the neck(Figure.3).Patient was NPO for two weeks and brief total parenteral nutrition (TPN) provided her calory.Finally,we succeeded to fistulized the perforation to the skin and control the mediastinitis(Figure.4).Patient regained oral feeding gradually after two weeks NPO. The follow-up esophagogram revealed the passage of the contrast to the distal esophagus with no leak and fistula.Early recognition of perforation could interrupt major operation to control catastrophic complication.Keywords: Esophageal Perforation, Esophagoscopy, Foreign Body
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IntroductionAlthough perforation of the esophagus, in the anterior cervical spine fixation, is well established, cases with delayed onset, especially cases that present pseudodiverticulum, are not common. In addition, management of the perforation in this situation is debated. Case Report: Delayed esophageal pseudodiverticulum was managed in two patients with a history of anterior spine fixation. Patients were operated on, the loose plate and screws were extracted, the wall of the diverticulum was excised, the perforation on the nasogastric tube was suboptimally repaired, and a closed suction drain was placed there. The NGT was removed on the 7th day and barium swallow demonstrated no leakage at the operation site; therefore, oral feeding was started without any problem.ConclusionIn cases with delayed perforation, fistula, or diverticulum removal of anterior fixation instruments, gentle repair of the esophageal wall without persistence on definitive and optimal perforation closure, wide local drainage, early enteral nutrition via NGT, and antibiotic prescription is suggested.Keywords: Anterior cervical spine fixation, Conservative management, Delayed postoperative complication, Esophageal perforation, Esophageal diverticulum, Fistula management, Plate fixation
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Spontaneous esophageal perforation or Boerhaave''s syndrome is an uncommon condition that may occur following forceful vomiting and lead to mediastinitis. It is associated with high mortality and morbidity in absence of therapy. We present a case of spontaneous esophageal perforation in a 63 year-old man who developed a right-sided effusion, an unusual presentation. This case report and the relevant literature reveal that delay in prompt surgical repair is associated with a high morbidity and mortality.Keywords: Esophageal perforation, Mediastinitis, Pleural effusion
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BackgroundAcute mediastinitis is a serious medical condition with a mortality rate of 30 to 40% or even higher. Early diagnosis with prompt and aggressive treatment is essential to prevent its rapid progression. We evaluated acute mediastinitis cases and analyzed the outcomes.Materials And MethodsA retrospective chart review was conducted on patients diagnosed with acute mediastinitis who were admitted to Mofid Children’s Hospital from January 2001 to January 2010.ResultsSeventeen patients aged 1 to 10 yrs. (mean =3.8 yrs) were evaluated including 12 (70%) boys and 5 (30%) girls. The most common symptoms were fever, dyspnea, cyanosis, tachycardia and tachypnea. The etiology of mediastinitis was iatrogenic esophageal perforation (EP), and related to manipulation in 13(77%), and leakage of esophageal anastomosis in 4 cases (33%). The underlying diseases were esophageal atresia in 2(12%), corrosive injury of the esophagus in 13(76%), congenital esophageal stenosis in one (6%), and gastroesophageal reflux esophagitis also in one (6%) patient. Patients with clinical symptoms were evaluated by immediate chest radiography, and gastrografin swallow. After early diagnosis, the patients received wide spectrum antibiotics and immediate mediastinal or thoracic drainage, followed by esophagostomy and gastrostomy. Only one case of endoscopic perforation was managed by NG tube. Fifteen patients (88%) survived successfully. We had 2(12%) cases of mortality in our study (one patient after esophageal substitution, mediastinal abscess and septicemia, and the other one developed esophageal perforation 6 months after early management and died of cardiac arrest during endoscopic dilation).ConclusionPrevention of acute mediastinitis is still a difficult challenge. As the prognosis is not good and patients have high mortality, rapid management is mandatory.Keywords: Acute mediastinitis, Esophageal perforation, Treatment, Survival, Children
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Between 1993-1996 seventy-three consecutive patients (33 M, 40 F, mean age 35.4) with newly diagnosed achalasia underwent one or more pneumatic dilatations with the Rigiflex balloon using a protocol of graded dilatation with a fixed inflation pressure of 10 psi and constant duration of 30 seconds for all patients without using fluoroscopy. Using Vantrappen's classification for assessment of response, excellent or good results were considered as cure and fair or poor results as failure. Duration of symptoms and the amount of weight loss before dilatation averaged 5.2 years and 10 kg, respectively. In 62 patients one, in 5 patients two, and in 4 patients three dilatations were performed. Dilatation failed in one patient because of previous surgery and was followed by perforation in one patient (1.4%) and bleeding in another patient (1.4%). Follow up period averaged 20 months (range 6-38 months) with a cure rate of 90% (57 excellent, 9 good) and failure rate of 6.8% (3 fair, 2 poor). We conclude that graded pneumatic dilatation without fluoroscopy is a safe and very effective treatment for achalasia with 90% of patients having a sustained response lasting at least for an average of 20 months.
Keywords: Achalasia, pneumatic dilatation, fluoroscopy, esophageal perforation
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