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Related Concept Videos

Esophageal Perforation-II: Clinical Manifestations and Management01:28

Esophageal Perforation-II: Clinical Manifestations and Management

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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:
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Esophageal Perforation-I: Introduction01:22

Esophageal Perforation-I: Introduction

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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....
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Esophageal Strictures-II: Clinical Features and Management01:26

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Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
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Peptic Ulcer Disease V: Surgical Management and Nursing Care01:25

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Surgical management and nursing care are crucial in treating Peptic Ulcer Disease (PUD). Here is an organized and enhanced overview of the surgical interventions and the associated nursing care for PUD:
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Esophageal Varices-II: Clinical Features and Management01:28

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Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
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Barrett Esophagus-II: Clinical Manifestations and Management01:21

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Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
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A multistep approach for managing a complex esophageal perforation.

Shiran Shetty1, Dronamraju Sujay Prabhath1, Balaji Musunuri1

  • 1Department of Gastroenterology & Hepatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.

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Summary

This case highlights a multistep endoscopic approach for complex esophageal perforation. A combination of stenting, endoscopic vacuum therapy, and tack-and-suture closure successfully managed a large defect when initial treatments failed.

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Area of Science:

  • Gastroenterology
  • Minimally Invasive Surgery
  • Endoscopy

Background:

  • Esophageal perforation presents significant morbidity and mortality.
  • Optimal treatment for large perforations remains debated.
  • Standard interventions like clips, stents, and suturing may be insufficient.

Purpose of the Study:

  • To demonstrate the necessity of a multistep endoscopic approach for complex esophageal perforations.
  • To present a case of a large esophageal perforation managed with sequential endoscopic interventions.

Main Methods:

  • An 85-year-old male with a 4-cm midesophageal perforation underwent initial stenting with a fully covered self-expandable metal stent (SEMS).
  • Following SEMS failure, endoluminal vacuum therapy (ENDOVAC) was applied using a modified device.
  • Definitive closure was achieved using a through-the-scope tack-and-suture device.

Main Results:

  • Initial SEMS placement did not resolve the perforation.
  • ENDOVAC therapy reduced the defect size but did not achieve complete closure.
  • The tack-and-suture device successfully closed the large esophageal defect, confirmed by gastrograffin study.

Conclusions:

  • Complex esophageal perforations may require a sequential, multistep endoscopic strategy.
  • Endoscopic vacuum therapy and tack-and-suture devices are valuable tools for managing large esophageal defects.
  • This case underscores the efficacy of a tailored, stepwise endoscopic intervention for challenging esophageal perforations.