Esophageal Perforation Home Remedy

Figure 27-7 Inadvertently swallowed brldgework. Attempted endoscopic removal resulted in extensive esophageal laceration and perforation, which was shown by the presence of mediastinal air. At exploratory thoracotomy, repair of the esophagus was not possible, and an esophagectomy with cervical esophagogastric anastomosis was carried out.

Cervical Esophageal Perforation

Figure 27-8 Delayed recognition of cervical esophageal perforation after attempted endotracheal intubation. The large abscess in the upper left thorax required transthoracic drainage.

Figure 27-9 Primary repair of esophageal perforation illustrating exposure of the esophageal perforation. A, Extension of the muscular tear proximal and distal to the injury to allow complete exposure of the mucosal defect. The inset demonstrates the damaged pouting mucosa initially seen on inspection of the injury. B, Mobilization of the submucosa away from the muscular coat to allow exposure of the defect surrounded by normal submucosa and both the proximal and distal extent of the mucosal injury by extension of the muscular tear. (From Whyte, R.I., Iannettoni, M.D., and Orringer, M.B.: Intrathoracic esophageal perforation: The merit of primary repair. J. Thorac. Cardiovasc. Surg., 109:140, 1995.)

Esophageal Tear Drawing Images

Figure 27-10 Technique of primary repair of esophageal perforation illustrating (A) closure of the defect with GIA surgical stapler after mobilization and exposure of the mucosal and submucosal tear beyond the muscular tear, and (B) approximation of the muscular coat over the suture line with a running absorbable suture. The stapler is applied over an intraesophageal bougie (inset) to healthy mucosa and submucosa, not to the inflamed edges of the defect. (From Whyte, R.I., Iannettoni, M.D., and Orringer, M.B.: Intrathoracic esophageal perforation: The merit of primary repair. J. Thorac. Cardiovasc. Surg., 109:140, 1995.)

Figure 27-11 Repair of a distal esophageal perforation and reinforcement with fundoplication. The fundoplication has been reduced below the diaphragm to prevent complications of a paraesophageal hernia. A nasogastric tube, decompressing gastrostomy, and feeding jejunostomy have been added. (From Orringer, M.B.: Complications of esophageal surgery and trauma. In Greenfield, L.J. [ed.]: Complications in Surgery and Trauma. Philadelphia, J.B. Lippincott, 1984, with permission.)

Figure 27-12 Pleural flap patch closure of a large esophageal defect. A, After mobilization of the esophagus, a pleural flap is raised. B, The flap is placed around the esophagus, covering the perforation. C, The flap is sutured to itself. Sutures are placed above and below at the margins of the flap and also the perforation itself, tacking the pleura firmly to the esophageal muscularis. (From Gricco, H.C., and Wilkins, F.W.: Esophageal repair following late diagnosis of intrathoracic perforation. Ann. Thorac. Cardiovasc. Surg., 20:337, 1975, by permission of The Society of Thoracic Surgeons.)

Pleural flap

Replacing Esophagus With Colon
Figure 27-13 Esophageal replacement with stomach in the native esophageal bed. A cervical esophagogastrostomy has been performed. (From Orringer, M.B., and Sloan, H.: Esophagectomy without thoracotomy. J. Thorac. Cardiovasc. Surg., 76:643, 1978, with permission.)
Oesophageal Reconstruction Colonic

Figure 27-14 Construction of an anterior thoracic esophagostomy to preserve maximal length of esophagus. A, The mobilized thoracic esophagus is placed on the anterior chest wall to determine the location of the stoma. B, The esophagus is then tunneled subcutaneously and the esophagostomy is constructed. Stomal appliances are easily applied to the flat surface of the chest, and the additional esophageal length provided by the technique often facilitates later reconstruction. (From Orringer, M.B.: Complications of esophageal surgery and trauma. In Greenfield, L.J. fed. J: Complications in Surgery and Trauma. Philadelphia, J.B. Lippincott, 1984, with permission.)

Different Types Breasts And Nipples

Figure 27-15 Technique of esophageal exclusion. A side cervical esophagostomy diverts oral secretions. Reflux of gastric and biliary secretions is prevented by an umbilical tape tied at the gastroesophageal junction. The tape is tied tightly enough to obstruct the lumen but not tight enough to cause mural ischemia. The vagus nerves are not included in the tie but lie superficial to it. (From Brewer, ¡.A., Carter, R., Mulder, G.A., and Stiles, Q.R..: Options in ¡he management of perforations of the esophagus. Am. J. Surg., 152:62, 1986, with permission.)

Esophageal Tear Drawing Images

Esophageal perforation Is virtually always an Indication for surgery except In patients with well-contained leaks with good Internal drainage. A minority of patients with poorly contained disruptions have been treated successfully non-operatively with tube thoracostomy for drainage or tube thoracostomy combined with esophageal Intubation to occlude the esophageal tear.1 ' 1 ' Despite occasional success with these conservative methods, non-operative therapy is contraindicated in most patients with esophageal disruption, and an aggressive approach, if necessary using an esophagectomy in those with intrinsic esophageal disease, is often less "radical" treatment in the long run. Meticulous primary repair of esophageal disruption, regardless of the duration of the tear, is an established principle in the management of this disastrous injury.

References

1. Ajalat, G.M., and Mulder, D.G.: Esophageal perforations: The need for an individualized approach. Arch. Surg., 119:1318, 1984.

2. Albin, J., Noel, T., Allan, K., et al.: Intrathoracic esophageal perforation with the Angelchik antireflux prosthesis: Report of a new complication. Gastrointest. Radiol., 10:330, 1985.

3. Altorjay, A., Kiss, J., Voros, A., et al.: The role of esophagectomy in the management of esophageal perforations. Ann. Thorac. Surg., 65:1433, 1998.

4. Ancona, E., Gayet, B.: Etiology, diagnostic localization and symptoms: A GEEMO questionaire. In Siewert, J.R., and Holscher, A.H. (eds.). Diseases of the Esophagus. Berlin, Springer-Verlag, 1988, p. 1327.

5. Anderson, K.D., Rouse, T.M., and Randolph, J.G.: A controlled trial of corticosteroids in children with corrosive injury of the esophagus. N. Engl. J. Med., 323:637, 1990.

6. Appelqvist, P., and Salmo, M.: Lye corrosion carcinoma of the esophagus: A review of 63 cases. Cancer, 45:2655, 1980.

7. Backer, C.L., LoCicero, J.D., Hartz, R.S., et al.: Computed tomography in patients with esophageal perforation. Chest, 98:1018, 1990.

8. Bacon, B.R., Camara, D.S., and Duffy, M.C.: Severe ulceration and delayed perforation of the esophagus after endoscopic variceal sclerotherapy. Gastrointest. Endosc., 33:311, 1987.

9. Bardaxoglou, E., Manganas, D., Meunier, B., et al.: New approach to surgical management of early esophageal thoracic perforation: Primary suture repair reinforced with absorbable mesh and fibrin glue. World J. Surg., 21:618, 1997.

10. Benda, T.J.: Perforating foreign body of the esophagus. Laryngoscope, 79:410, 1969.

11. Benjamin, I., Olsen, A.M., and Ellis, F.H., Jr.: Esophagopleural fistula: A rare postpneumonectomy complication. Ann. Thorac. Surg., 7:139, 1969.

12. Berger, R.L., and Donato, A.T.: Treatment of esophageal disruption by intubation: A new method of management. Ann. Thorac. Surg., 13:27, 1972.

13. Berne, C.J., Shader, A.E., and Doty, D.B.: Treatment of effort rupture of the esophagus by epigastric celiotomy. Surg. Gynecol. Obstet., 129:277, 1969.

14. Bigler, F.C.: The use of a Foley catheter for removal of blunt foreign bodies from the esophagus. J. Thorac. Cardiovasc. Surg., 51:759, 1966.

15. Bisgaard, T., Wojdemann, M., Heindorff, H., et al.: Nonsurgical treatment of esophageal perforations after endoscopic palliation in advanced esophageal cancer. Endoscopy, 29:155, 1997.

16. Bladergroen, M.R., Lowe, J.E., and Postlethwait, R.W.: Diagnosis and recommended management of esophageal perforation and rupture. Am. Thorac. Surg., 43:235, 1986.

17. Brewer, L.A., Carter, R., Mulder, G.A., et al.: Options in the management of perforations of the esophagus. Am. J. Surg., 152:62, 1986.

18. Brooks, J.W.: Foreign bodies in the air and food passages. Ann. Surg., 175:720, 1972.

19. Cameron, J.L., Kieffer, R.F., Hendrix, T.R., et al.: Selective nonoperative management of contained intrathoracic esophageal disruptions. Ann. Thorac. Surg., 27:404, 1979.

20. Chung, R.S., and DenBesten, L.: Fiberoptic endoscopy in treatment of corrosive injury of the stomach. Arch. Surg., 110:125, 1975.

21. Curci, J.J., and Horman, M.J.: The importance of early diagnosis and treatment. Ann. Surg., 145:30, 1983.

22. Davies, A.P., and Vaughan, R.: Expanding mesh stent in the emergency treatment of Boerhaave's syndrome. Ann. Thorac. Surg., 67:1482, 1999.

23. Defore, W.W., Jr., Mattox, K.L., Hansen, H.A., et al.: Surgical management of penetrating injuries of the esophagus. Am. J. Surg., 134:134, 1977.

24. Derbes, V.J., and Mitchell, R.E.: Hermann Boerhaave's "Atrocis, nec descripti prius, morbi historia." First translation of classic case report of rupture of esophagus, with annotations. Bull. Med. Lib. Assoc. 43:217, 1955.

25. Dooling, J.A., and Zick, H.R.: Closure of an esophagopleural fistula using onlay intercostal pedicle graft. Ann. Thorac. Surg., 3:553, 1967.

26. Engleman, R.M., Spencer, F.C., and Berg, P.: Postpneumonectomy esophageal fistula: Successful one-stage repair. J. Thorac. Cardiovasc. Surg., 59:811, 1970.

27. Estrera, A., Taylor, W., Mills, L.J., et al.: Corrosive burns of the esophagus and stomach: A recommendation for an aggressive surgical approach. Ann. Thorac. Surg., 41:276, 1986.

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