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World Journal of Emergency Surgery :... 2019The esophagus traverses three body compartments (neck, thorax, and abdomen) and is surrounded at each level by vital organs. Injuries to the esophagus may be classified... (Review)
Review
The esophagus traverses three body compartments (neck, thorax, and abdomen) and is surrounded at each level by vital organs. Injuries to the esophagus may be classified as foreign body ingestion, caustic ingestion, esophageal perforation, and esophageal trauma. These lesions can be life-threatening either by digestive contamination of surrounding structures in case of esophageal wall breach or concomitant damage of surrounding organs. Early diagnosis and timely therapeutic intervention are the keys of successful management.
Topics: Caustics; Esophageal Perforation; Esophagoscopy; Esophagus; Foreign Bodies; Humans; Tomography, X-Ray Computed
PubMed: 31164915
DOI: 10.1186/s13017-019-0245-2 -
Forensic Science, Medicine, and... Sep 2018Although death from food is not an uncommon finding in forensic facilities worldwide, the range of underlying lethal mechanisms and associated conditions that should be... (Review)
Review
Although death from food is not an uncommon finding in forensic facilities worldwide, the range of underlying lethal mechanisms and associated conditions that should be sought at the time of autopsy is quite disparate. Deaths may occur from i) infectious agents including bacteria, viruses, protozoa, cestodes, nematodes and prions; ii) natural toxins including amanita toxins, tetrodotoxin, ciguatera and scombroid; iii) anaphylaxis; iv) poisoning; v) mechanical issues around airway and gut obstruction and/or perforation; and vi) miscellaneous causes. Food-related deaths are important in terms of global mortality, and thus autopsies need to be comprehensive with full ancillary testing. Medicolegal matters may involve issues concerning likely exposure to infectious agents, possible foods ingested, the declared content and possible components of food, the significance of toxicological analyses, and aspects of duty of care in cases of café coronary syndrome and gastroenteritis while in care.
Topics: Airway Obstruction; Anaphylaxis; Esophageal Perforation; Food; Food Hypersensitivity; Food Microbiology; Foodborne Diseases; Forensic Medicine; Humans; Mediastinal Diseases; Obesity; Pica; Prader-Willi Syndrome
PubMed: 28710688
DOI: 10.1007/s12024-017-9899-9 -
Annals of Translational Medicine Feb 2018Esophageal perforation may occur spontaneously, iatrogenically or in connection with traumas. Sepsis may develop in connection with mediastinal and pleural exposure in a... (Review)
Review
Esophageal perforation may occur spontaneously, iatrogenically or in connection with traumas. Sepsis may develop in connection with mediastinal and pleural exposure in a very short time as a consequence of disintegration of the esophagus. Esophageal perforation is an emergency accompanied with a high level of mortality and morbidity. Rate of mortality for the perforations in the thoracic region is higher than that in the cervical and abdominal regions. Delay in diagnosis and treatment is the most important factor to affect the mortality. A quick and true diagnosis of esophageal perforation is prerequisite for a successful treatment. There is no certain consensus in relation with the optimal treatment of that life-threatening condition. However, in the event that perforation is detected early in a healthy esophagus, then primary repair is recommended. When it is detected late, nonoperative conservative treatment would be appropriate. The rates of mortality for the operations following a period of 24 h after rupture formation are higher than 50%. Esophagectomy is a type of an operation that is to be considered in the event of an end stage benign esophageal disease or of a large esophageal damage that does not allow primary repair. Significant decrease has been observed in the morbidity and mortality of esophageal perforation due to the improvements in the endoscopical techniques today. Minimally invasive techniques, in which drug eluting stents come first, will become an important step for the treatment of esophageal perforations in the forthcoming years.
PubMed: 29610732
DOI: 10.21037/atm.2017.04.25 -
Journal of Thoracic Disease Mar 2018Esophagectomy for benign disease is uncommonly used but it is an important option to consider in those patients who have lost function of this organ. Esophageal... (Review)
Review
Esophagectomy for benign disease is uncommonly used but it is an important option to consider in those patients who have lost function of this organ. Esophageal resection is, in fact considered as a last resort for benign disease, after multiple failed conservative treatments, when the primary disease is not amenable to other treatments and the esophagus has become non-functional leading to very poor quality of life. The indications for esophagectomy for benign diseases can be divided into three major categories: obstruction, perforation and dysmotility. The process leading to organ failure and the need for resection for each specific disease will be discussed in an attempt to provide guidance as to when an esophagectomy is appropriate.
PubMed: 29707359
DOI: 10.21037/jtd.2018.01.165 -
British Journal of Hospital Medicine... Jan 2023Achalasia, characterised by the absence of peristalsis and failure of relaxation of the lower oesophageal sphincter, is an uncommon degenerative condition that results... (Review)
Review
Achalasia, characterised by the absence of peristalsis and failure of relaxation of the lower oesophageal sphincter, is an uncommon degenerative condition that results in dysphagia. If left untreated it can lead to aspiration, oesophageal perforation, oesophagitis and malnutrition. It has a range of immune, allergic, viral and genetic aetiological causes. Successful diagnosis relies on the use of oesophagogastroduodenoscopy, barium swallow and oesophageal manometry to characterise the severity of the disease and to rule out underlying malignancy. Although no treatment can reverse the degenerative process, therapeutic strategies including lifestyle modification, medication, endoscopic and operative intervention can help to reduce symptoms. This article reviews the latest methods used to investigate and manage achalasia.
Topics: Humans; Esophageal Achalasia; Esophageal Sphincter, Lower; Deglutition Disorders; Manometry; Esophagoscopy
PubMed: 36708337
DOI: 10.12968/hmed.2022.0437 -
Journal of Thoracic Disease Mar 2017Traditionally, gold standard treatment for an acute esophageal perforation has been operative repair. Over the past two decades, there has been a paradigm shift towards... (Review)
Review
Traditionally, gold standard treatment for an acute esophageal perforation has been operative repair. Over the past two decades, there has been a paradigm shift towards the use of esophageal stents. Recent advances in biomaterial allowed a new generation of stents to be manufactured that combined (I) a non-permeable covering; (II) radial force sufficient to occlude a transmural esophageal injury and (III) improved ease of removability. The amalgamation of these developments set the stage for utilizing esophageal stents as part of the management algorithm of an acute esophageal perforation. This provides a safe and less invasive treatment route in lieu of direct primary repair and its well-documented significant failure rate. Esophageal stent placement for failed operative repair or esophageal leaks also had the potential to minimize the need for esophageal resection and diversion. When included in a multimodality hybrid treatment protocol, esophageal stents can optimize healing success rates and minimize the risks of adverse complications. This review summarizes the modern history of esophageal stent use in the treatment of esophageal perforation as well as the evidenced based recommendations for the use of esophageal stent placement in the treatment of acute esophageal perforation.
PubMed: 28446977
DOI: 10.21037/jtd.2017.03.100 -
Medical Journal, Armed Forces India Dec 2016
PubMed: 28050085
DOI: 10.1016/j.mjafi.2015.12.004 -
The Eurasian Journal of Medicine Feb 2022Although esophageal perforation is rare, it is a life-threatening condition. The esophagus is very sensitive to rupture and perforation due to the absence of a serosal...
Although esophageal perforation is rare, it is a life-threatening condition. The esophagus is very sensitive to rupture and perforation due to the absence of a serosal layer. More than half of the esophageal perforations are iatrogenic and most occur during endoscopy. Around 55% of esophageal injuries occur in the intrathoracic region, 25% in the cervical region, and 20% in the abdominal region. Clinical manifestations and mortality are related to various components such as the etiology, localization, type of injury, severity of contamination, injury to adjacent mediastinal structures, and time from perforation to treatment. When perforation occurs in the esophagus, saliva, stomach contents, bile fluid, and other secretions may pass into the mediastinum causing mediastinal emphysema, inflammation followed by mediastinal necrosis, and chemical mediastinitis. Early clinical suspicion and imaging are essential for successful treatment. Despite advances in technology and treatment, the morbidity and mortality rate due to esophageal perforation is still higher than 20% according to the reported studies. Until now, the main treatment of esophageal perforation was the surgical approach. Nowadays, endoluminal procedures such as endoscopic vacuum therapy, endoscopic stent placement, endoscopic clip closure, endoscopic suturing, and tissue adhesives have started to be applied more. In this review, the minimally invasive and endoscopic approach methods suitable for esophageal perforation according to the characteristics of the patients and the structure of the perforation were examined.
PubMed: 35307640
DOI: 10.5152/eurasianjmed.2022.21135 -
Internal Medicine (Tokyo, Japan) Jan 2022
Topics: Esophageal Diseases; Esophageal Perforation; Humans; Mediastinal Diseases; Rupture, Spontaneous
PubMed: 34219113
DOI: 10.2169/internalmedicine.7807-21