FA07.02: ESOPHAGEAL PERFORATION: A RETROSPECTIVE, SINGLE CENTER OUTCOMES

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 13-14
Author(s):  
Balazs Kovacs ◽  
Takahiro Masuda ◽  
Ross Bremner ◽  
Michael Smith ◽  
Jasmine Huang ◽  
...  
Keyword(s):  
Esophageal Perforation ◽  
Surgical Intervention ◽  
Conflicts Of Interest ◽  
Retrospective Chart Review ◽  
Esophageal Resection ◽  
High Morbidity ◽  
Single Center ◽  
Tertiary Referral Hospital ◽  
Exclusion Criteria ◽  
Icu Stay

Abstract Background Esophageal perforation (EP) though uncommon has high morbidity and mortality. Aim of this study is to evaluate the outcomes at a tertiary referral hospital. Methods After IRB approval patients with EP between May 2014 and Sept 2017 were identified. Retrospective chart review was done to collect data. Exclusion criteria were: age under 18, leak following esophageal resection and esophageal stenting in previous year. Pittsburgh esophageal perforation severity score (PS) was calculated for each patient. Results During study period 56 patients (70% men) with EP met inclusion and exclusion criteria with a mean age and BMI of 60 Yrs. 27.1 kg/m2 respectively. Most common causes were iatrogenic (43%) and Boerhaave's (21%). Nearly 3/4th patients presented to the hospital within 24h of onset. The site of perforation was thoracic (67.9%), cervical (16.1%) and abdominal (16.1%). Overall mortality within 1 month was 5.7% (3 cases) compared to predicted (5.8 cases, 10.4%) based on Pittsburgh score (P > 0.05). See Table 1 for PS at presentation, management and ICU stay. Conclusion In our single center experience the leading cause of EP are iatrogenic injury and Boerhaave's syndrome. PS correlated well with need for aggressive surgical intervention and length of ICU stay. Use of endoluminal stents was higher than previously reported. Stents with or without additional surgical intervention can be a viable option in a subset of patients. Disclosure All authors have declared no conflicts of interest.

589 Reoperative Intervention in Patients With Mesh At Hiatus Is Associated With High Morbidity and High Incidence of Esophageal Resection - Single Center Experience

2013 ◽  
Vol 144 (5) ◽  
pp. S-1053
Author(s):  
Kalyana C. Nandipati ◽  
Maria Bye ◽  
Se Ryung Yamamoto ◽  
Pradeep K. Pallati ◽  
Tommy H. Lee ◽  
...  
Keyword(s):  
Esophageal Resection ◽  
High Morbidity ◽  
Single Center ◽  
Single Center Experience ◽  
High Incidence

PS01.089: A DIFFERENT FIXATION METHOD TO PREVENT STENT MIGRATION IN ESOPHAGEAL FISTULAS AND PERFORATIONS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 75-75
Author(s):  
Atila Eroglu ◽  
Yener Aydin ◽  
Ali Ulas ◽  
Omer Yilmaz
Keyword(s):  
Esophageal Perforation ◽  
Suture Material ◽  
Conflicts Of Interest ◽  
Flexible Endoscopy ◽  
Stent Migration ◽  
Suture Technique ◽  
Esophageal Stent ◽  
Fixation Method ◽  
High Morbidity ◽  
Delivery Catheter

Abstract Background Esophageal perforation is an emergency condition characterized by high morbidity and mortality. The removable esophageal stent is an effective method of treatment in cases with esophageal perforation as they allow minimal invasive and rapid nutrition. Stent migration is an important problem in perforations and fistulas where there is no obstruction in the esophageal lumen. Several methods are used to prevent stent migration, including different stent types and endoscopic suture technique. In this study, we aimed to present a method that we use in our clinic to prevent stent migration. Methods We retrospectively evaluated 12 consecutive patients who underwent stent placement and were fixed for migration prevention for esophageal fistula or perforation between January 2013 and February 2018 in our clinic. All of the cases were self-expandable metallic stents. The stent was removed from the delivery catheter without insertion and the suture material was passed through the head and reattached to the catheter. The stent was placed using flexible endoscopy. The suture material placed on the upper part of the stent was taken out of the mouth of the patient. After the stent is inserted and the delivery catheter is removed, the nasal catheter (aspiration catheter) was inserted and removed from the mouth. The suture material in the mouth was connected to the tip of the aspiration catheter. The aspiration catheter was withdrawn. The suture material removed from the patient's nose was fixed like a nasogastric catheter. After 3 or 4 days from the procedure, the suture was cut. Migration of the stent was followed by direct radiography. Results Seven cases were female and five cases were male. The mean age was 51.1 ± 12.7 years (range 20–72 years). No migrations were observed in any of the cases. After a mean of 19.5 days (range 11–23 days), the stent was removed endoscopically. In all cases, perforation and fistula improved. Conclusion We think that the esophageal stent fixation method is a simple and effective method to prevent migration. Disclosure All authors have declared no conflicts of interest.

PS01.110: ACUTE NECROTIZING ESOPHAGITIS WITH ESOPHAGUS PERFORATION, TREATED BY THORACOSCOPIC ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 81-81
Author(s):  
Ryujiro Akaishi ◽  
Yusuke Taniyama ◽  
Tadashi Sakurai ◽  
Takahiro Heishi ◽  
Hiroshi Okamoto ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Conflicts Of Interest ◽  
Esophageal Resection ◽  
Endoscopic Examination ◽  
Resected Specimen ◽  
Thoracic Esophagus ◽  
Esophageal Mucosa ◽  
Acute Necrotizing ◽  
Esophagus Perforation ◽  
Black Pigmentation

Abstract Background Acute necrotizing esophagus is defined as the diffuse black pigmentation of the esophagus due to the necrosis of the esophageal mucosa, and so called ‘black esophagus’ from its endoscopic findings. The prevalence is only 0.001∼0.2%, although the mortality rate is up to 32%. Methods 67 years old female with medical history of diabetes mellitus, transported to the emergency room with hematemesis and conscious disorder. She had suffered from nausea and epigastralgia for two days. Her general status was in shock vitals and didn’t respond to rehydration. After intubation, emergency endoscopic examination revealed black pigmentation of the esophageal mucosa and diagnosed as acute necrotizing esophagitis. Antibiotics and blood absorption therapy had been started and the patient gradually stabilized. 1 week after the admission, esophagus perforation was suspected from the significant increase of the right pleural effusion and free air at the esophagus wall and the mediastinum on CT scan. Emergency thoracoscopy was performed and found that the esophagus was edematous and adventitia was colored into black. The esophagectomy with esophagostomy and enterostomy was performed. Results On resected specimen, mucosal necrosis was found only on squamous epithelium with three perforating areas in the middle to lower thoracic esophagus. No signs of inflammation nor ischemia was found on the gastric mucosa of the esophagogastric junction. After the operation, patient recovered generally well, except the severe stenosis of the cervical esophagus had developed. Although endoscopic dilation had been constantly performed, the reconstruction remains unsolved issue. Conclusion In acute necrotizing esophagitis, stabilization of the patient's condition by treating comorbid diseases is extremely important. Improving the nutritional status in addition to the administration of antacids and antibiotics is also required. Surgical intervention should be performed when perforating mediastinitis or abscess formation occurs. Primary closure shouldn’t be attempted, and esophageal resection with delayed reconstruction should be considered in addition to drainage. In this case, we could successfully rescued the patient with necrotic esophagitis by performing surgical intervention promptly. It is important to detect the esophagus perforation and mediastinitis early, not to miss the chance of surgical intervention for curative treatment. Disclosure All authors have declared no conflicts of interest.

scholarly journals Abdominal tuberculosis requiring surgical intervention: A 10-year single-center experience

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
Hana Arbab ◽  
Nawal Khan ◽  
Farhana Amanullah ◽  
Lubna Samad
Keyword(s):  
Surgical Intervention ◽  
Early Recognition ◽  
Enterocutaneous Fistula ◽  
Retrospective Chart Review ◽  
Wound Dehiscence ◽  
Abdominal Tuberculosis ◽  
High Morbidity ◽  
Single Center Experience ◽  
Threatening Condition ◽  
Emergency Surgical Intervention

Background: Although uncommon in children, abdominal tuberculosis (ATB) can be a life-threatening condition with a subset requiring emergency surgical intervention.  This study aims to determine the presentation, surgical procedures performed, and outcomes in children affected by abdominal tuberculosis. Methods: A retrospective chart review of all children undergoing surgical intervention for ATB from July 2007 to December 2018 was conducted. Data were analyzed using SPSS version 22. Results: Of 340 children with a diagnosis of ATB seen at the Indus Hospital’s TB clinic, 14 (4%) underwent laparotomy. Females were affected more commonly (57%), with a mean age at presentation of 11 years (range 8-14). Nine children required laparotomy for documented perforation, while 5 had an intestinal obstruction. Most children (n=10) had an established diagnosis of ATB before the surgical intervention; 2 children had completed 6–9 months anti-tuberculous treatment (ATT) courses, while 8 children had been on ATT for a mean period of 2.5 months at the time of developing acute surgical symptoms.  Diversion ileostomy was made in 64%.  Postoperative complications included sepsis (n=4), wound infection (n=3), abdominal collection (n=2), enterocutaneous fistula (n=2), and abdominal wound dehiscence requiring formal closure (n=2). There were 4 mortalities (29%); 10 patients were discharged after a median in-hospital stay of 12 days (range 6-35) of which 6 with ileostomies underwent reversal after completion of the ATT course. Conclusion: ATB has high morbidity and mortality. Perforation and obstruction can occur during or after the completion of ATT.  Management requires early recognition and surgical intervention as indicated.

scholarly journals Heterotopic caval valve implantation for the management of severe tricuspid regurgitation: a case series

2020 ◽  
Author(s):  
Aidan Sharkey ◽  
Ronny Munoz Acuna ◽  
Kiran Belani ◽  
Ravi K Sharma ◽  
Omar Chaudhary ◽  
...  
Keyword(s):  
Medical Therapy ◽  
Tricuspid Regurgitation ◽  
Surgical Intervention ◽  
Symptom Relief ◽  
Vena Cava ◽  
Case Series ◽  
High Morbidity ◽  
Severe Tricuspid Regurgitation ◽  
Maximal Medical Therapy ◽  
Valve Implantation

Abstract Background Severe tricuspid regurgitation (TR) is a complex condition that can be difficult to treat medically, and often surgical intervention is prohibited due to the high morbidity and mortality associated with this intervention. In patients who have failed maximal medical therapy and have progressive symptoms related to their severe TR, heterotopic caval valve implantation (CAVI) offers potential for symptom relief for these patients. Case summary We present two cases of patients with severe TR with symptoms of heart failure that were refractory to medical therapy. Due to extensive comorbidities in these patient’s surgical intervention was deemed unsuitable and the decision was made to proceed with heterotopic CAVI in order to try and control their symptoms. Both patients successfully underwent the procedure and had an Edwards SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA, USA) implanted in the inferior vena cava/right atrium junction. In both patients, there was improvement in the postoperative haemodynamics as measured by invasive and non-invasive methods. Successful discharge was achieved in both patients with improvement in their symptoms. Discussion Selective use of heterotopic CAVI to treat symptomatic severe TR that is refractory to medical therapy may be a viable option to improve symptoms in those patients that are unsuitable for surgical intervention.

Surgical intervention, adverse effects and radiotherapy: A retrospective single center study

2018 ◽  
Vol 17 (12) ◽  
pp. e2673
Author(s):  
P. Stelmach ◽  
P. Rajwa ◽  
G. Rempega ◽  
M. Kępiński ◽  
J. Ryszawy ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Surgical Intervention ◽  
Single Center ◽  
Single Center Study ◽  
Center Study

scholarly journals Period prevalence and identification challenges of viral haemorrhagic fever suspect cases in a tertiary referral hospital in Guinea: a cross-sectional, retrospective study of triage and emergency room patient profiles

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Manuel Raab ◽  
Lisa M. Pfadenhauer ◽  
Vinh-Kim Nguyen ◽  
Dansira Doumbouya ◽  
Michael Hoelscher ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Emergency Room ◽  
Retrospective Chart Review ◽  
Laboratory Diagnostics ◽  
Haemorrhagic Fever ◽  
Case Definitions ◽  
Tertiary Referral Hospital ◽  
Cross Sectional ◽  
Viral Haemorrhagic Fever ◽  
Suspect Case

Abstract Background A functioning Viral Haemorrhagic Fever (VHF) surveillance system in countries at risk for outbreaks can reduce early transmission in case of an outbreak. Surveillance performance depends on the application of suspect case definitions in daily clinical practice. Recommended suspect case criteria during outbreaks are designed for high sensitivity and include general symptoms, pyrexia, haemorrhage, epidemiological link and unexplained death in patients. Non-outbreak criteria are narrower, relying on the persistence of fever and the presence of haemorrhagic signs. Methods This study ascertains VHF suspect case prevalence based on outbreak and non-outbreak criteria in a Guinean regional hospital for a period of three months. The study further describes clinical trajectories of patients who meet non-outbreak VHF suspect case criteria in order to discuss challenges in their identification. We used cross-sectional data collection at triage and emergency room to record demographic and clinical data of all admitted patients during the study period. For the follow-up study with description of diagnostic trajectories of VHF suspect cases, we used retrospective chart review. Results The most common symptoms of all patients upon admission were fever, tiredness/weakness and abdominal pain. 686 patients met EVD outbreak criteria, ten adult patients and two paediatric patients met study-specific non-outbreak VHF suspect case criteria. None of the suspect cases was treated as VHF suspect case and none tested positive for malaria upon admission. Their most frequent discharge diagnosis was unspecific gastrointestinal infection. The most common diagnostic measures were haemoglobin level and glycaemia for both adults and for children; of the requested examinations for hospitalized suspect cases, 36% were not executed or obtained. Half of those patients self-discharged against medical advice. Conclusions Our study shows that the number of VHF suspect cases may vary greatly depending on which suspect case criteria are applied. Identification of VHF suspect cases seems challenging in clinical practice. We suggest that this may be due to the low use of laboratory diagnostics to support certain diagnoses and the non-application of VHF suspect case definitions in clinical practice. Future VHF suspect case management should aim to tackle such challenges in comparable hospital settings.

Timing of Surgical Intervention in Patients with Pituitary Apoplexy and Cranial Nerves Deficits: Single-Center Experience

2021 ◽  
Author(s):  
Mohammad Alahmari ◽  
Shaun Kilty ◽  
Andrea Lasso ◽  
Fatmahalzahra Banaz ◽  
Sepideh Mohajeri ◽  
...  
Keyword(s):  
Pituitary Apoplexy ◽  
Surgical Intervention ◽  
Cranial Nerves ◽  
Single Center ◽  
Single Center Experience

384 Post-Operative ICU Admission for Elective Craniotomy for Intra-axial Brain Tumor Resection

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 291-292
Author(s):  
Farhan A Mirza ◽  
Catherine Y Wang ◽  
Thomas Pittman
Keyword(s):  
Brain Tumor ◽  
Pediatric Patients ◽  
Prolonged Mechanical Ventilation ◽  
Pediatric Population ◽  
External Ventricular Drain ◽  
Tumor Resection ◽  
Retrospective Chart Review ◽  
Icu Admission ◽  
Icu Stay ◽  
Brain Tumor Resection

Abstract INTRODUCTION We reviewed our practice at the University of Kentucky in order to assess the safety of admitting adult and pediatric patients to floor beds after craniotomy, exclusively for intra-axial brain tumor resection. METHODS Retrospective chart review of patients, adults and pediatric, who underwent craniotomy by a single surgeon (TP) for intra axial brain tumor resection between January 2012 and December 2015. 413 patient charts were reviewed, 16 were omitted due to incomplete records. RESULTS >421 craniotomies for intra axial brain tumor resection were performed. 397 patients underwent surgery, 35 of whom were <18 years of age.188 females and 209 males. 351 patients (331 adults, 20 pediatric) were admitted to floor beds. In this group, length of operation was <4 hours in 346 patients (99.1%) and >4 hours in only 5 patients (0.9%). 3 patients (0.8%) required transfer to ICU within 24 hours of floor admission. 55 adult patients required ICU stay for various reasons: 9 patients had pre-operative or intra operative EVD placement; 15 patients required prolonged ventilation; 1 patient had to be taken back to the operating room for hemorrhage evacuation; 5 had intraventricular tumors and were planned ICU admissions; 26 patients were admitted pre-operatively to an ICU bed on a non neurosurgical service and were returning to their assigned beds. In the pediatric population, 15 patients required ICU stay: 8 were for EVD management and 7 for prolonged operation or frequent neurological evaluations. In this group, the length of operation was <4 hours in 40 patients(57.1%) and >4 hours in 30 patients (42.9%). CONCLUSION Admitting adult and pediatric patients to floor beds after craniotomy for intra-axial brain tumor resection is safe. There are some conditions that mandate ICU admission: these include prolonged mechanical ventilation and the presence of an external ventricular drain.

scholarly journals 1002. Epidemiology of Pneumococcal Bacteremia in a Large Tertiary Center

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S298-S298
Author(s):  
Aristotle Asis ◽  
Esmeralda Gutierrez-Asis ◽  
Ali Hassoun
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
The United States ◽  
Morbidity And Mortality ◽  
Hospital Length Of Stay ◽  
Smoking History ◽  
High Morbidity ◽  
Icu Stay ◽  
Pneumococcal Bacteremia ◽  
Tertiary Center

Abstract Background Streptococcus pneumoniae remains an important cause of bacteremia in the United States with high morbidity and mortality despite readily available treatment and vaccines. Increased incidence of bacteremia observed during 2017–2018 season. Methods Retrospective chart review of patients admitted with pneumococcal bacteremia over the last two winter seasons. Demographics, laboratory data, ICU stay, need for ventilation or pressor, comorbidities, and mortality were collected. Results Fifty-three patients enrolled. 62% admitted during 2017–2018. Sixty-six percent white, 60% male, mean BMI 27 (38% had normal BMI). Mean age was 55 years (1–93) (57% &gt; 61). Mean hospital length of stay was 7.8 days (1–30). More than 40% required ICU stay. The use of NPPV, vasopressors, and mechanical ventilation were 6%, 15%, and 17%, respectively. Most common presentation: dyspnea 30% and fever 18%. Smoking history (55%). Eighty percent of these patients had pneumonia. Resistance to penicillin 9% and intermediate susceptibility 6%. Resistance to erythromycin 44% and trimethoprim-sulfamethoxazole 12% which increased during winter 2017 (52% and 12%) compared with winter 2016 (30% and 10%). Only 2% of patients with pneumonia had positive sputum culture for pneumococcus and 62% had positive serum pneumococcal antigen with bacteremia. Positive co-detection of bacterial or viral targets in sputum using Multiplex PCR did not correlate with mortality and hospital stay but they were more likely needed ICU stay, use of vasopressor and mechanical ventilation. 43% of empiric therapy was as recommended by IDSA guidelines. Comparing 2016 vs. 2017 seasons, mortality (15% vs. 6%), hospital stay (9 days vs. 7 days), use of NPPV (5% vs. 6%) mechanical ventilation (15% vs. 18%) and vasopressor (5% vs. 21%). No correlation between influenza infection and bacteremia. Overall 6-month mortality and re-admission rate was 9% and 2%, respectively. Mortality was higher in overweight patients (60% vs. 20%), non-smokers (40% vs. 20%), coronary artery disease (40%) and congestive heart failure (40%). Conclusion Pneumococcal bacteremia cause significant morbidity and mortality, we observed less mortality and hospital stay, but more use of NPPV, mechanical ventilation, and vasopressor during 2017–2018 season which had widespread influenza like activity. Disclosures All authors: No reported disclosures.

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