P201 LAPAROSCOPIC TRANSHIATAL OMENTAL REPAIR OF IATROGENIC ESOPHAGEAL PERFORATION IN ACHALASIA

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Nebbia Martina ◽  
Riva Pietro ◽  
Da Roit Anna ◽  
Basato Silvia ◽  
Pansa Andrea ◽  
...  
Keyword(s):  
Esophageal Perforation ◽  
Delayed Diagnosis ◽  
Vital Signs ◽  
Laparoscopic Approach ◽  
Pleural Empyema ◽  
Water Soluble ◽  
Patch Repair ◽  
Barium Swallow ◽  
Esophageal Wall ◽  
Left Hemithorax

Abstract Aim Laparoscopic transhiatal omental patch repair(OPR) of esophageal perforation after pneumatic balloon dilatation(PBD) for achalasia. Background&Methods In August 2018 a 72yrs woman with a history of dysphagia for solids and liquids, nocturnal regurgitation and chest pain had a diagnosis of achalasia. After inhalation during a barium swallow the patient developed fever, respiratory insufficiency and worsening of vital signs leading to ICU and intubation. She developed a right-pleural empyema, massive pneumothorax and right-upper lobe abscess, requiring thoracotomy and right-superior lobectomy. She had been scheduled for a Per Oral Endoscopic Myotomy in November. After the submucosal tunnel, the procedure had been suspended due to presence of fibrosis. In December the patient underwent a first PBD up to 30mm with symptoms resolution and 2kg weight regain. In February, few hours after a second PBD up to 35mm, she complained mild pain at the left hemithorax and fever. 24hrs later a CTscan with water-soluble-contrast revealed a 3cm long esophageal perforation 5cm above the diaphragm and left paraesophageal mediastinal abscess without pleural involvement. Endoscopic treatment was excluded for significant dilatation of the esophagus and the fragile esophageal wall. Because of the frailty status of the patient, the delayed diagnosis, the high risk of a direct suture of the esophageal wall through a left thoracotomy, the even higher risk of an emergency esophagectomy, we performed a laparoscopic approach. Limited dissection of the esophagogastric-junction and of the left diaphragmatic crura allowed access to the abscess cavity, no attempt to direct suture was done, a drain was placed, a pedicled omental flap was realized filling the cavity and repairing the esophageal defect. A jejunostomy was placed. Results The post-op period was uneventful; a CTscan with per-os contrast on POD3 and POD9 didn’t show any collection. The patient started an oral semisolid-diet on POD11. An EGDS on POD19 confirmed the presence of the OPR in the esophageal lumen and after 2-months showed a completely re-epithelialized esophagus. Conclusions Laparoscopic trans hiatal OPR of esophageal perforation in achalasia proved to be a minimally invasive and effective procedure in this patient due to its immunogenic and angiogenetic properties.

scholarly journals RETRACTED ARTICLE: Conservative management for an esophageal perforation in a patient presented with delayed diagnosis: a case report

Cases Journal ◽  
2009 ◽  
Vol 2 (1) ◽  
Author(s):  
Konstantinos Tsalis ◽  
Konstantinos Blouhos ◽  
Dimitrios Kapetanos ◽  
Theodore Kontakiotis ◽  
Charalampos Lazaridis
Keyword(s):  
Case Report ◽  
Conservative Management ◽  
Esophageal Perforation ◽  
Delayed Diagnosis ◽  
Retracted Article

Pleural Empyema: An Unusual Presentation of Esophageal Perforation

Respiration ◽  
1999 ◽  
Vol 66 (4) ◽  
pp. 366-368 ◽  
Author(s):  
A. Solomonov ◽  
L.A. Best ◽  
L. Goralnik ◽  
A.E. Rubin ◽  
M. Yigla
Keyword(s):  
Esophageal Perforation ◽  
Pleural Empyema ◽  
Unusual Presentation

One-stage operation for treatment after delayed diagnosis of thoracic esophageal perforation

1992 ◽  
Vol 53 (4) ◽  
pp. 617-620 ◽  
Author(s):  
Chau-Hsiung Chang ◽  
Pyng Jing Lin ◽  
Jen-Ping Chang ◽  
Ming-Jang Hsieh ◽  
Ming-Chung Lee ◽  
...  
Keyword(s):  
Esophageal Perforation ◽  
Delayed Diagnosis ◽  
One Stage

scholarly journals Delayed diagnosis of myocardial infarction in a young man with a blunt chest trauma

2019 ◽  
Vol 11 (3) ◽  
pp. 251-253
Author(s):  
Marzieh Nikparvar ◽  
Sayed Mohammadbagher Asghari ◽  
Hossein Farshidi
Keyword(s):  
Myocardial Infarction ◽  
Trauma Patient ◽  
Chest Trauma ◽  
Delayed Diagnosis ◽  
Vital Signs ◽  
Ct Scanning ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Chest X Ray ◽  
St Elevation

A 19 year old man was admitted to emergency department (ED) because of motorcycle to motorcycle accident. In ED he was evaluated as a multiple trauma patient and after overnight observation, was discharged with stable vital signs (VS) next morning. Twenty four hours later, he developed chest pain and dyspnea, and was admitted to ED for the second time. This time he was evaluated as a chest trauma patient and chest X ray and CT scanning were performed. According to cardiology consult, an electrocardiogram was recorded and extensive anterolateral ST elevation myocardial infarction (STEMI) was confirmed. Coronary angiography revealed total thrombotic occlusion of left anterior descending artery (LAD) from ostium. Percutaneous coronary intervention (PCI) was performed and LAD stented successfully. After 10 days of ICU admission, he was discharged with an ejection fraction (EF) of 35%.

Transdiaphragmatic herniation after transthoracic esophagectomy: an underestimated problem

2020 ◽  
Vol 33 (12) ◽  
Author(s):  
Hans F Fuchs ◽  
Laura Knepper ◽  
Dolores T Müller ◽  
Isabel Bartella ◽  
Christiane J Bruns ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Emergency Surgery ◽  
Locally Advanced ◽  
Treatment Algorithm ◽  
Laparoscopic Approach ◽  
High Rate ◽  
Neoadjuvant Radiochemotherapy ◽  
Left Hemithorax ◽  
Surgical Data ◽  
Diaphragmatic Herniation

Summary Diaphragmatic transposition of intestinal organs is a major complication after esophagectomy and can be associated with significant morbidity and mortality. This study aims of to analyze a large series of patients with this condition in a single high-volume center for esophageal surgery and to suggest a novel treatment algorithm. Patients who received surgery for postesophagectomy diaphragmatic herniation between October 2003 and December 2017 were included. Retrospective analysis of demographic, clinical and surgical data was performed. Outcomes of measure were initial clinical presentation, postoperative complications, in-hospital mortality and herniation recurrence. A total of 39 patients who had surgery for postesophagectomy diaphragmatic herniation were identified. Diaphragmatic herniation occurred after a median time of 259 days following esophagectomy with the highest prevalence between 1 and 12 months. A total of 84.6% of the patients had neoadjuvant radiochemotherapy prior to esophagectomy. The predominantly effected organ was the transverse colon (87.2%) prolapsing into the left hemithorax (81.6%). A total of 20 patients required emergency surgery. Surgery always consisted of reposition of the intestinal organs and closure of the hiatal orifice; a laparoscopic approach was used in 25.6%. Major complications (Dindo–Clavien ≥ IIIb) were observed in 35.9%, hospital mortality rate was 7.7%. Three patients developed recurrent diaphragmatic herniation during follow-up. Postesophagectomy diaphragmatic herniation is a functional complication of the late postoperative course and predominantly occurs in patients with locally advanced adenocarcinoma having chemoradiation before Ivor–Lewis esophagectomy. Due to a high rate of emergency surgery with life-threatening complications not a ‘wait-and-see’ strategy but early surgical repair may be indicated.

scholarly journals Multiple-Dose Pharmacokinetics and Safety of a Novel Broad-Spectrum Cephalosporin (BAL5788) in Healthy Volunteers

2004 ◽  
Vol 48 (7) ◽  
pp. 2576-2580 ◽  
Author(s):  
Anne Schmitt-Hoffmann ◽  
Lars Nyman ◽  
Brigitte Roos ◽  
Michael Schleimer ◽  
Jill Sauer ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Multiple Dose ◽  
Vital Signs ◽  
Volume Of Distribution ◽  
Water Soluble ◽  
Pharmacokinetic Data ◽  
Serious Adverse Events ◽  
Water Compartment ◽  
Dose Study ◽  
Multiple Dose Pharmacokinetics

ABSTRACT BAL5788 is the water-soluble prodrug of BAL9141, a novel broad-spectrum cephalosporin with potent bactericidal activity against methicillin-resistant Staphylococcus aureus (MRSA) and penicillin-resistant Streptococcus pneumoniae. Safety and pharmacokinetic data from a multiple-dose study with 16 healthy male volunteers are reported. Subjects were randomized to receive BAL5788 at 500 or 750 mg (as BAL9141 equivalents; n = 6 subjects per dose) or placebo (n = 2 subjects per dose). The doses were given as 200-ml infusions over 30 min once daily on days 1 and 8 and twice daily on days 2 to 7. BAL5788 was well tolerated, with no severe or serious adverse events (AEs) or dosing-related changes in laboratory parameters, electrocardiographic findings, or vital signs. Drug accumulation in plasma was negligible during the dosing period. The results of pharmacokinetic analyses agreed well with data reported from a previous single-ascending-dose study. The elimination half-life of BAL9141 was about 3 h. The volume of distribution at steady state was equal to the volume of the adult extracellular water compartment. BAL9141 was predominantly eliminated in urine, and renal clearance of the free drug corresponded to the normal glomerular filtration rate in adults. After multiple infusions of 750 mg, the mean concentrations of BAL9141 in plasma exceeded the MIC at which 100% of MRSA isolates are inhibited (4 μg/ml) for approximately 7 to 9 h, corresponding to 58 to 75% of a 12-h dosing interval.

Esophageal Perforation during Gastric Bypass: Delayed Diagnosis and Management

2007 ◽  
Vol 17 (7) ◽  
pp. 986-988 ◽  
Author(s):  
Santiago A. Endara ◽  
Armando J. Serrano ◽  
Bernardo A. Sandoval ◽  
Gerardo A. Davalos
Keyword(s):  
Gastric Bypass ◽  
Esophageal Perforation ◽  
Delayed Diagnosis ◽  
Diagnosis And Management

scholarly journals APPENDICEAL MUCOCOELE WITH PARTIAL NON ROTATION OF GUT – A RARE CASE REPORT

2020 ◽  
pp. 1-2
Author(s):  
Shirish Bhagvat ◽  
Nikhil Dhimole
Keyword(s):  
Abdominal Pain ◽  
Rare Case ◽  
Patient Management ◽  
Clinical Presentation ◽  
Delayed Diagnosis ◽  
Laparoscopic Approach ◽  
Intermittent Abdominal Pain ◽  
Atypical Clinical Presentation ◽  
Rare Case Report

Mucocoele of appendix and partial non-rotation of gut are rare pathological entities, and when they are present together they pose diagnostic and therapeutic difficulties due to atypical clinical presentation. This dilemma of varied clinical presentation can lead to delayed diagnosis and complications, thereby adversely affecting patient management and outcome. We report a 33 year old lady, presenting with intermittent abdominal pain in the periumbillical since 3 months diagnosed to have an appendiceal mucocoele with partial non rotation of gut on imaging. The patient underwent laparoscopic appendectomy and was discharged on post operative day 1 following an uneventful course with no recurrence on 6 months of follow up. Histopathology of the specimen confirmed the diagnosis of mucocoele of appendix with no evidence of malignancy. To our knowledge, this is the first reported case of mucocoele of appendix with partial non rotation of gut managed with minimally invasive laparoscopic approach.

scholarly journals A case of esophageal perforation: Clinical and diagnostic management in emergency medicine

2018 ◽  
Vol 13 (2) ◽  
Author(s):  
Marco Di Serafino ◽  
Maurizio Martorano ◽  
Pamela Delmonaco ◽  
Chiara Gullotto ◽  
Andrea Baglioni ◽  
...  
Keyword(s):  
Foreign Body ◽  
Esophageal Perforation ◽  
Delayed Diagnosis ◽  
Penetrating Trauma ◽  
Foreign Body Ingestion ◽  
Delay In Diagnosis ◽  
Diagnostic Management ◽  
Esophagus Perforation ◽  
Boerhaave Syndrome ◽  
Diagnostic Work

Esophageal perforation is a welldefined and severe clinical condition. The associated mortality rates range between 5% and 40% and are worsened by delayed diagnosis. Rapid diagnosis and therapy provide the best chance for survival; however, a delay in diagnosis is common, resulting in substantial morbidity and mortality. There are several aetiologies of esophagus perforation. Most esophageal ruptures are secondary to medical instrumentation. Other causes are Boerhaave syndrome, toxic ingestions and radiation, foreign body ingestion, penetrating trauma, and, rarely, blunt chest trauma. We reported the clinical management and the diagnostic work-up case of esophagus perforation due to the foreign body ingestion.

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