Cases reported "Iatrogenic Disease"

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1/17. Laparoscopic repair of a chronic diaphragmatic hernia.

    Diaphragmatic injuries that remain undetected after an acute traumatic event may lead to the formation of a diaphragmatic hernia. Symptoms of a chronic diaphragmatic hernia are related to the incarceration of abdominal contents in the defect or to impingement of the lung, heart, or thoracic esophagus by abdominal viscera. A 49-year-old woman with a symptomatic chronic diaphragmatic hernia from an unrecognized iatrogenic injury to the left hemidiaphragm sought treatment. The diaphragmatic injury occurred 2 years earlier when a low, left-sided chest tube was placed for a persistent pleural effusion 2 weeks after a lower lobectomy for an aspergilloma. The patient's diaphragmatic hernia was diagnosed after an upper gastrointestinal series and an esophagogastroduodenoscopy. Approximately 75% of her stomach was incarcerated in the diaphragmatic defect. The diaphragmatic hernia was repaired laparoscopically using a 9 cm x 10-cm polytetrafluoroethylene patch sewn with nonabsorbable, interrupted, horizontal mattress sutures. Improvement of video technology, laparoscopic instruments, and surgical skills has allowed surgeons to expand the boundaries of advanced therapeutic laparoscopy. These factors facilitated the authors' standard tension-free prosthetic repair of a chronic diaphragmatic hernia using minimally invasive techniques.
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ranking = 1
keywords = esophagus
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2/17. Iatrogenic perforation of the esophagus.

    Iatrogenic perforation of the esophagus occurs rarely, and is most frequently seen in preterm and low birth weight infants. This is a report of 2 cases of iatrogenic perforation of the esophagus, outlining aspects of diagnosis and management.
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ranking = 6
keywords = esophagus
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3/17. Thoracoscopic repair of instrumental perforation of the oesophagus: first report.

    BACKGROUND: Perforation of the oesophagus is a life-threatening condition requiring early recognition and repair to prevent mediastinitis and death. Primary closure with mediastinal drainage is recognised as the treatment of choice for patients presenting within 24 hours. Many are frail, however, and unsuitable for major surgery. AIM: To report the first case of thoracoscopic repair of the oesophagus for oesophageal perforation following instrumentation. methods: Flexible endoscopy revealed a 10cm perforation in the right lower oesophagus. With the gastroscope in the oesophagus, four thoracoports were introduced. Using suction and irrigation, the pleural cavity was suctioned free of debris and a 10cm longitudinal tear of the right lateral aspect of the oesophagus was repaired using interrupted polyglactin sutures through all layers. RESULTS: The patient tolerated the procedure well and made an uncomplicated recovery. CONCLUSION: The uncomplicated recovery of this frail patient without need for blood transfusions or assisted ventilation supports the notion that the thoracoscopic approach may have significant advantages. With increased experience and technical refinements there should be less reluctance to refer these patients for earlier definitive surgical repair.
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ranking = 9
keywords = esophagus
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4/17. Successfully treated case of cervical abscess and mediastinitis due to esophageal perforation after gastrointestinal endoscopy.

    Perforations of the esophagus are uncommon complications of flexible gastrointestinal endoscopy. Perforations after endoscopy are likely to occur in the cervical esophagus, where fiber insertion is difficult anatomically. The diagnosis should be made as soon as possible, because mediastinitis and sepsis frequently develop following esophageal perforations. The surgical strategies are dependent on the location of the perforations and the condition of the patients. For a successful outcome, surgery is a preferred treatment for most perforation cases, and non-operative treatment, such as antibiotics, parental nutrition, and no food intake by mouth, should be applied carefully.
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ranking = 2
keywords = esophagus
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5/17. Sonographic detection of a malpositioned feeding tube causing esophageal perforation in a neonate.

    We report a case of esophageal perforation caused by a malpositioned feeding tube in a neonate of extremely low birth weight, 632 g. The infant had respiratory distress, which increased rapidly when he was 6 days old. radiography revealed right-sided hydrothorax that had not been evident a day earlier but no sign of a perforated esophagus. We performed sonography, which revealed fluid in the right pleural cavity and extra-esophageal placement of the feeding tube. Analysis of a fluid specimen obtained on thoracocentesis indicated that the fluid was feeding formula. The feeding tube's misplacement was confirmed sonographically by injecting a small amount of sterile distilled water into the tube and visualizing its entry into the pleural cavity. The feeding tube was removed, and antimicrobial agents were administered. When the infant was 15 days old, feeding resumed through another tube, the placement of which was verified radiographically. The infant was discharged when he was 118 days old with no severe complications, although he had mild chronic lung disease. Because radiography did not reveal the tube's misplacement in this case, we believe that the use of sonography can contribute to an early diagnosis of esophageal perforation in such cases.
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ranking = 1
keywords = esophagus
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6/17. Iatrogenic esophagobronchial fistula arising in irradiated Barrett's esophagus.

    A 47-yr-old male underwent a right upper lobectomy for stage IIB bronchoalveolar carcinoma followed by 4600 Gy of irradiation. One year later a fistula formed from an ulcerated region of Barrett's esophagus into the left main bronchus. Bronchotomy repair with onlay patch intercostal muscle flap and esophageal repair with serratus anterior muscle flap plus postoperative esophageal stent placement for stricture resulted in good functional results.
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ranking = 5
keywords = esophagus
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7/17. Improved repair of cervical esophageal fistula complicating anterior spinal fusion: free omental flap compared with pectoralis major flap. Report of four cases.

    Esophageal injury is a serious complication of anterior cervical fusion. A team approach to the management of these cases is described. The authors performed spinal assessment, control of the fistula, and interposition of a vascularized flap between the spine and the esophagus. They compared the overall efficacy of the pectoralis major flap (pedicled; two cases) and omental flap (free; two cases).
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ranking = 1
keywords = esophagus
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8/17. Unusual presentation of an iatrogenic esophageal perforation in a newborn.

    Spontaneous rupture of esophagus (Boerhaave's syndrome) in neonates is a rare occurrence. However iatrogenic perforation of the esophagus is not that uncommon, especially in a premature. The presentation of esophageal perforation is rather stereotyped. In the present case however patient presented with unusual features.
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ranking = 2
keywords = esophagus
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9/17. Pneumomediastinum and abdominal pain: which correlation?

    The case of a female patient with abdominal pain, fever and dyspnea appeared abruptly, is reported. Two days previously the patient underwent endoscopic colic polypectomy. Preliminary abdominal and chest X-ray showed colic and tenual air-fluid levels, a modest amount of pneumomediastinum and soft tissue emphysema of the neck. The cause of the latter finding was referable to five sites of origin: the lung parenchyma, mediastinal airways, the esophagus, the neck and the abdominal cavity. For symptom worsening thoracoabdominal CT was performed. It confirmed the pneumomediastinum and soft tissue emphysema of the neck and presence of intra and retroperitoneal free air as for perforation. colonoscopy is a routine procedure in the diagnosis and therapy of colonopathies, but colic iatrogenic perforation is a dangerous complication not to be underestimated.
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ranking = 1
keywords = esophagus
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10/17. Thoracic empyema--a delayed complication of excluded benign thoracic oesophagus. Case report.

    Delayed 'blow-out' of retained thoracic oesophagus, 2 years after its exclusion for iatrogenic oesophageal perforation, gave rise to thoracic empyema. Oesophageal exclusion performed for benign, non-caustic conditions tends particularly to cause complications. Excision of the oesophageal remnant should therefore be considered in restoration of alimentary-tract continuity.
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ranking = 5
keywords = esophagus
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