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Related Concept Videos

Esophageal Perforation-I: Introduction01:22

Esophageal Perforation-I: Introduction

Esophageal perforation is a severe medical condition characterized by a breach in the integrity of the esophageal wall. This breach can occur due to various factors such as trauma, medical procedures, or underlying diseases. When the esophageal wall is compromised, it allows food, fluids, and digestive juices into the chest cavity or adjacent structures, leading to potential complications and health risks.
The location of esophageal perforation can vary, occurring anywhere along the esophagus.
Esophageal Perforation-II: Clinical Manifestations and Management01:28

Esophageal Perforation-II: Clinical Manifestations and Management

Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
Hiatal Hernia01:25

Hiatal Hernia

A hiatal hernia is the abnormal protrusion of the stomach or other abdominal organs through the esophageal hiatus of the diaphragm into the thoracic cavity.Normally, the gastroesophageal junction (GEJ) lies below the diaphragm and is supported by the phrenoesophageal membrane, the diaphragmatic crura, and connective tissues. Weakening of these structures—due to aging, congenital defects like a short esophagus, or increased intra-abdominal pressure from coughing, obesity, pregnancy, or heavy...
Pneumothorax-I01:26

Pneumothorax-I

A pneumothorax is a condition where air builds up in the space between the lung and the chest wall, causing the lung to collapse. This condition arises when air enters the space between the parietal and visceral pleura, disrupting the negative pressure essential for lung inflation. This can lead to a partial or complete collapse of the lung.
Pneumothorax can be even further classified as spontaneous, traumatic, and tension pneumothorax.
Esophageal Varices-I: Introduction01:24

Esophageal Varices-I: Introduction

Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
Esophageal Strictures-I: Introduction01:30

Esophageal Strictures-I: Introduction

Esophageal strictures involve abnormal narrowing or tightening of the esophagus. They vary in length and severity, ranging from mild constriction to complete obstruction, and are classified as benign (noncancerous) or malignant (cancerous).
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...

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Thoracic esophageal perforations.

Paul D Kiernan1, Sandeep J Khandhar, Daniel L C Fortes

  • 1Section of Thoracic Surgery, Department of Surgery, Inova Fairfax Hospital, Inova Health System, Falls Church, Virginia 22042, USA. pdkkiernan@aol.com

The American Surgeon
|January 27, 2011
PubMed
Summary
This summary is machine-generated.

Aggressive surgical intervention for thoracic esophageal perforation offers high survival rates, especially when performed within 24 hours. Even in severe cases, various treatments like cervical diversion and stenting show effectiveness.

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Area of Science:

  • Thoracic Surgery
  • Gastroenterology
  • Surgical Outcomes

Background:

  • Thoracic esophageal perforation is a critical condition requiring timely and effective management.
  • Reviewing a large single-center experience provides insights into treatment efficacy over two decades.

Purpose of the Study:

  • To evaluate the outcomes of various treatment modalities for thoracic esophageal perforation.
  • To identify factors influencing survival and functional recovery in patients with esophageal perforation.

Main Methods:

  • Retrospective review of patients with thoracic esophageal perforation treated between June 1, 1988, and March 1, 2009.
  • Analysis of different treatment approaches including primary repair, resection and reconstruction, cervical diversion, and endoesophageal stenting.
  • Assessment of survival rates and swallowing function based on treatment strategy and timing.

Main Results:

  • Aggressive surgical intervention within 24 hours yielded a 97% survival rate, compared to 89% after 24 hours.
  • Primary repair offered 100% survival in uncomplicated cases, while resection and reconstruction achieved 96% survival in cases with phlegmon or obstruction.
  • Cervical diversion demonstrated 89% survival, and endoesophageal stenting as primary treatment had an 88% survival rate.
  • 95% of survivors reported good to excellent swallowing ability.

Conclusions:

  • Early aggressive surgical intervention is associated with superior survival in thoracic esophageal perforation.
  • Multiple treatment options, including nonoperative and minimally invasive approaches, can be effective depending on the clinical scenario.
  • Despite the severity of esophageal perforation, functional swallowing outcomes are generally favorable among survivors.