Cases reported "Esophageal Perforation"

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1/26. Surgical management of necrotizing candida esophagitis.

    Invasive esophageal candidiasis produced transmural necrosis leading to perforation in 2 patients aged 10 and 27 years. Both patients survived after esophageal resection and complete diversion. One patient with acute leukemia and neutropenia experienced systemic candidiasis, which resolved after esophagectomy. esophagectomy and diversion for yeast-induced necrosis may lead to complete recovery and resolution of disseminated candidiasis when combined with systemic antifungal therapy.
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keywords = esophagitis
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2/26. esophageal perforation: a rare complication of zollinger-ellison syndrome.

    Spontaneous perforation of the esophagus is a rare manifestation of zollinger-ellison syndrome (ZES). Failure to recognize its existence can lead to an unsuccessful treatment of the esophageal perforation. We present a rare case of reflux esophagitis-induced esophageal perforation in a patient with ZES. Presence of a gastrinoma should be considered when recurrent or complicated reflux esophagitis is encountered.
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ranking = 0.5006765500705
keywords = esophagitis, reflux
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3/26. Conservative management of a case of cervical esophagus perforation with mediastinal abscess and bilateral pleural effusion.

    Perforation of the cervical esophagus is a serious circumstance. mediastinitis secondary to esophageal perforations is associated with high mortality. There is a lack of consensus on the optimal treatment for this condition. We present a case of conservative treatment in an 82-year-old woman with cervical esophagus rupture associated with mediastinal abscess and bilateral pleural effusion resulting from dilatation of a malignant esophageal stricture. Conservative treatment consisted on broad-spectrum intravenous antibiotic therapy, antireflux measures and gastrostomy was satisfactory. Treatment of the esophageal perforation should be individualized to the circumstances of each patient. Advances in antibiotic and nutritional therapy, early institution of treatment and observance of the indications, made possible a more frequent use of a conservative therapeutic approach.
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ranking = 0.00033827503524797
keywords = reflux
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4/26. Successful management of a nonmalignant esophageal perforation with a coated stent.

    This case report details our experience in the management of an iatrogenic perforation that recurred after two surgical repairs. A self-expanding coated stent was eventually placed to seal the esophageal perforation with significant improvement in the clinical condition of the patient. At 1-year follow-up, the patient is tolerating an oral diet with no evidence of esophageal leak or gastroesophageal reflux. This case report and a literature review suggest that self-expanding coated stents may be a useful salvage option in the management of inveterate nonmalignant esophageal perforations.
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ranking = 0.00033827503524797
keywords = reflux
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5/26. Infectious necrotizing esophagitis: outcome after medical and surgical intervention.

    BACKGROUND: Immunodeficiency predisposes to invasive esophageal infections. The treatment of perforation, respiratory fistula, and necrosis due to transmural esophageal infection is guided by anecdote. We wish to determine treatment and outcome of local complications of necrotizing esophagitis. methods: We report our experience over a 7-year period and review published reports since 1976. We treated 4 patients and found 21 reported patients with perforation (11/25), fistula (8/25), and necrosis (6/25) at a mean age of 35 years. Twenty-one patients were immunodeficient (84%) due to acquired immunodeficiency syndrome in 8, acute leukemia in 6, renal transplant in 3, diabetes mellitus, renal failure, and corticosteroids in 1 each. Pathogenic organisms were fungal in 15 cases, viral in 7, and bacterial in 7. RESULTS: Treatment consisted of antibiotic therapy in 13 patients and surgical intervention combined with antibiotic therapy in 12: esophagectomy in 6, esophageal stenting and drainage in 2, drainage alone in 2, and salivary diversion in 2. overall mortality was 48% (12/25). mortality without surgical intervention was 90% (9/10) and with surgical intervention 27% (3/11). One of 6 patients undergoing esophagectomy (17%) died. The difference in mortality was due to sepsis, which was the cause of death in 8 patients treated with medical intervention and only 1 treated with surgical intervention. CONCLUSIONS: Local complications of necrotizing esophagitis have a high mortality due to sepsis. Surgical intervention, in particular esophagectomy, controls sepsis in published case reports and should be considered in selected patients. Further study is required to determine the true prevalence of these complications and the outcome of intervention.
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ranking = 1.5
keywords = esophagitis
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6/26. Cerebral embolization resulting from esophageal-atrial fistula.

    A rare but catastrophic complication of nontraumatic esophageal perforation is the formation of an esophageal-left atrial fistula. Although surgical correction of this condition should be possible, failure to recognize it antemortem has thus far prevented such intervention. A woman with long-standing severe esophagitis, was admitted with hematemesis and acute neurologic abnormalities that progressed to coma and death. A similar picture of chronic esophagitis terminating in uppergastrointestinal-tract bleeding accompanied by neurologic signs was seen in the three previously reported cases as well. Recognition of this symptom complex should permit future cases to be diagnosed clinically, and, it is hoped, corrected.
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ranking = 0.5
keywords = esophagitis
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7/26. esophageal perforation as a complication of EndoCinch endoluminal gastroplication.

    Endoscopic gastroplasty is being promoted as a new minimally invasive procedure for the treatment of gastroesophageal reflux disease. In the case presented here, however, we encountered abdominal perforation as a severe complication of this procedure. Because immediate action was taken when the symptoms developed, and by maintaining close collaboration with the surgeons, it was possible to keep the treatment minimally invasive: the leakage was detected endoscopically and the defect was closed laparoscopically and covered by a fundoplication. This experience emphasises the importance of appropriate management of complications as part of the evaluation of new endoscopic methods.
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ranking = 0.00033827503524797
keywords = reflux
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8/26. Congenital esophageal stenosis owing to ectopic tracheobronchial remnants.

    BACKGROUND/PURPOSE: Congenital esophageal stenosis owing to tracheobronchial remnants (TBR) is a rare condition. Inappropriate treatment often is carried out before the correct diagnosis is established. For a better understanding and management of this disease, patients with TBR treated at our hospital and collected from the literature are reviewed to evaluate the course of onset, associated anomalies, methods of diagnosis and treatment, and outcomes. methods: Three patients treated at our hospital and 59 patients identified from the literature were included in the study. Gender, age at onset of symptoms, age at definitive treatment, esophagographic findings, pathology, methods of treatment, and outcomes of the 62 patients were recorded and analyzed. RESULTS: Boys slightly predominated (33:28, 1 unknown gender). Symptoms of dysphagia and regurgitation developed at the mean age of 3.2 /- 4.5 months. Definitive treatment was carried out at the mean age of 2.6 /- 3.0 years with a time lag of 2.0 /- 2.5 years from the onset of symptoms. Twenty-five patients had associated anomalies with esophageal atresia being the most prevalent. Esophagography showed segmental stenosis over the distal third of the esophagus in all patients except one. The esophagographic findings could be classified into 3 types: type Ia, 10 cases; Ib, 15 cases; type II, 14 cases; type III, 3 cases. A nonyielding esophageal stenosis without inflammation was the characteristic esophagoscopic finding. Esophagoscopic dilatation of the stenosis was attempted in 26 patients, but all failed, and 2 patients suffered esophageal perforation. Surgical resection was mandatory for all patients to restore their esophageal continuity. postoperative complications included anastomotic stenosis, anastomotic leakage, hiatal hernia, and gastroesophageal reflux. CONCLUSIONS: TBR should be suspected in patients who present with a typical history of dysphagia after ingestion of solid food and have characteristic esophagographic and esophagoscopic findings. It has a strong tendency to occur with esophageal atresia. Esophagoscopic dilatation is ineffective and may render the patient at risk for esophageal perforation. Operation is the treatment of choice and carries little morbidity and mortality.
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ranking = 0.00033827503524797
keywords = reflux
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9/26. Esophageal stents as a salvage therapy for non-malignant iatrogenic esophageal perforations.

    BACKGROUND: Esophageal non-malignant perforations are severe life-threatening conditions. The current treatment is either surgical or conservative. methods: We report a case series of 3 consecutive patients (1 female, 2 male; 34-68 years) treated with expandable covered stents for non-malignant iatrogenic esophageal perforations. OBSERVATIONS: In our series, 3 out of 3 patients sealed their perforations and resumed normal oral intake. Complications observed were 2 stent migrations, which occurred at 6 and 11 months after stent insertion, a stenosis due to acid reflux treated by another stent insertion above the first one. On the basis of the data available, it appears that esophageal stents was successful in 82% of the cases. The mortality and complication rates were of 7% and 32% respectively. The main complications observed were peptic stenosis above the stent and fistulas. CONCLUSION: These results are promising but need to be confirmed in large-scale prospective studies. Mediastinal drainage remains mandatory when sepsis is present.
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ranking = 0.00033827503524797
keywords = reflux
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10/26. Spontaneous perforation in the ringed esophagus.

    A 54-year-old man presented to the ER with chest pain. He underwent an upper endoscopy revealing a large linear esophageal tear and a CT chest showed free air in the mediastinum. He was managed conservatively and was discharged 2 days later. An UGI series revealed a distal esophageal stricture. He was commenced on esomeprazole for gastroesophageal reflux symptoms and his dysphagia improved significantly. Upper endoscopy revealed multiple rings throughout the esophagus. Biopsies from the distal and mid-esophagus were normal. The underlying pathophysiology, in patients with dysphagia and a ringed esophagus has evoked debate in the literature. Opinions range from underlying gastroesophageal reflux disease (GERD) to eosinophilic esophagitis (EE). Our patient's symptoms of GERD and dysphagia resolved with proton pump inhibitor therapy. Normal histology excluded underlying EE. There have been a few case reports of esophageal perforation in patients with a ringed esophagus, and underlying EE, but none with spontaneous perforation occurring in a 'ringed esophagus'. Perforations in the upper and mid-esophagus can usually be managed conservatively, while those in the distal esophagus often need surgery due to the high risk of developing mediastinitis. However, our patient, despite sustaining a large tear in the distal esophagus, did well with conservative management. This case demonstrates that spontaneous perforation in the ringed esophagus, with normal underlying histology can occur in the distal esophagus and may not require surgery.
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ranking = 0.2506765500705
keywords = esophagitis, reflux
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