Surgical management of esophageal perforation: role of primary closure

2019 ◽  
Vol 27 (3) ◽  
pp. 192-198 ◽  
Author(s):  
Vu Huu Vinh ◽  
Nguyen Viet Dang Quang ◽  
Nguyen Van Khoi
Keyword(s):  
Hospital Admission ◽  
Esophageal Perforation ◽  
Primary Closure ◽  
Primary Repair ◽  
Time Interval ◽  
Mortality And Morbidity ◽  
Thoracic Level ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening

Objective Esophageal perforation is a life-threatening condition associated with high mortality and morbidity. Ambiguous clinical presentation is one of the most common causes of delayed and difficult diagnosis of esophageal perforation. In this retrospective single-center study, we reviewed the outcome of primary closure in patients with esophageal perforation between 2009 and 2017. Methods The data of 65 patients attending our department of thoracic surgery (from 2009 to 2017) for esophageal perforation were reviewed. Primary repair was attempted in 63 patients irrespective of the site of perforation and time interval between injury and hospital admission. In intrathoracic lesions, continuous mediastinal and pleural irrigation was undertaken, whereas in cervical perforations, gauze packing and local irrigation were performed. Jejunotomy was carried out in patients with inadequate healing. Results Of the 65 patients, 63 underwent primary closure and 2 were left to heal spontaneously. The majority of patients ( n = 44) had an esophageal perforation at the thoracic level, and only one was admitted early (<24 h after injury). Among the 63 patients managed with primary closure, 55 had satisfactory healing with one surgery. Healing was delayed in the other 10 patients. No mortality was reported. Conclusions Esophageal perforation can be well managed by primary closure, irrespective of the time interval between injury and hospital admission and the site of perforation. Conservative management might lead to an increased rate of complications such as empyema or necrotizing mediastinitis, and increased morbidity and mortality.

Life-threatening complications of Ludwig’s angina: a series of cases in a developed country

2021 ◽  
Vol 14 (4) ◽  
pp. e240429
Author(s):  
Catarina Mendes Silva ◽  
Joana Paixão ◽  
Pedro Neves Tavares ◽  
João Pedro Baptista
Keyword(s):  
Developed Countries ◽  
Developed Country ◽  
Mortality And Morbidity ◽  
Space Infection ◽  
Threatening Condition ◽  
Life Threatening ◽  
Ludwig’S Angina ◽  
Reduction Of Mortality ◽  
Modern Era ◽  
Ludwig's Angina

Ludwig’s angina is a deep neck space infection defined as a rapidly progressive bilateral cellulitis of the submandibular space. In spite of being an uncommon entity in developed countries and the reduction of mortality and morbidity due to modern era of antibiotics, improved imaging and airway management, it is still an important and potentially life-threatening condition. The authors present 3 cases of Ludwig’s angina that occurred in a developed country, and that required admission in intensive care unit and extensive surgical and medical treatment.

Anaphylaxis in the OR—Causes, Recognition, and Treatment

2018 ◽  
pp. 199-206
Author(s):  
Surangama Sharma ◽  
Lovkesh Arora
Keyword(s):  
Body Mass Index ◽  
Laparoscopic Cholecystectomy ◽  
Operating Room ◽  
Clinical Manifestations ◽  
Preventative Measures ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Elective Laparoscopic Cholecystectomy

Anaphylaxis in the operating room is a life-threatening condition that can evolve rapidly. As an anesthesiologist, it is important to understand the pathophysiology, diagnose the condition, recognize the inciting agent/agents, and manage it appropriately. It is equally important to confirm the diagnosis for preventing a catastrophic event from happening in future. This chapter defines anaphylaxis, discusses the clinical manifestations and most common causes, and describes ways it can be diagnosed. It also considers treatment and preventative measures. The chapter uses a case study of a 55-year-old female, weighing 85 kg and a body mass index of 36 with no other known comorbidities, who is scheduled to undergo elective laparoscopic cholecystectomy.

scholarly journals Unexpected source of Proteus mirabilis bacteraemia

2018 ◽  
Vol 11 (1) ◽  
pp. bcr-2018-226744
Author(s):  
Sureshkumar Nagiah ◽  
Rassam Badbess
Keyword(s):  
Proteus Mirabilis ◽  
Elderly Woman ◽  
High Morbidity ◽  
Vascular Risk ◽  
Infected Aneurysm ◽  
Gram Negative ◽  
Delay In Diagnosis ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening

Mycotic (infected) aneurysm involving the thoracic aorta is an exceedingly rare and life-threatening condition that is associated with high morbidity and mortality. We report an unusual source of Proteus mirabilis bacteraemia thought to be due to an infected aneurysm in the thoracic aortic arch in an elderly woman. Source of gram-negative bacteraemia is usually isolated to an intra-abdominal or a pelvic source. Proteus bacteraemia from an intrathoracic pathology is very uncommon, and in this case led to a delay in diagnosis. Although an infected aneurysm is a rare source of gram-negative bacteraemia, it must always be considered when common causes of bacteraemia have been ruled out especially in patients with vascular risk factors.

scholarly journals Maternal and foetal outcome of eclampsia in a referral hospital

2017 ◽  
Vol 6 (3) ◽  
pp. 1021
Author(s):  
Mousumi Das Ghosh ◽  
Vinita Singh ◽  
Alokananda Ray
Keyword(s):  
Antenatal Care ◽  
Early Recognition ◽  
Mode Of Delivery ◽  
Ventilatory Support ◽  
Adequate Treatment ◽  
Mortality And Morbidity ◽  
Foetal Mortality ◽  
Threatening Condition ◽  
Life Threatening ◽  
Foetal Outcome

Background: Eclampsia is a life-threatening condition, common in developing countries with high fatality rate. It is a cause of maternal and foetal mortality and morbidity. The aim of the study is to determine the maternal and foetal outcome in Tata Main Hospital, Jamshedpur, Jharkhand, India.Methods: All cases of eclampsia were analysed from January 2012 to December 2014 from admission to discharge or death of the patient.  Age, parity, antenatal care, interval between attack and admission, blood pressure on admission, gestational age and mode of delivery were  taken into account. There were 135 cases of eclampsia out of 14572 deliveries. Only singleton pregnancies were analysed.Results: The incidence of antepartum eclampsia was 84.4%, intrapartum 3% and postpartum 12.5 %. 83% patients were primigravida, 33% less than 20 yrs,42% had no antenatal checkup and 45% had < 4 visits. Only 15% patients received magnesium sulphate before referral to the hospital. There were four maternal deaths and twenty-one perinatal deaths. Eleven patients needed ventilatory support, four developed pulmonary oedema,  two patients had respiratory depression and three patients had renal failure.Conclusions: Hypertensive disease in pregnancy requires proper antenatal care, early recognition and referral, adequate treatment and timely delivery.

scholarly journals Diabetic ketoacidosis in pregnancy

2018 ◽  
Vol 7 (7) ◽  
pp. 2945
Author(s):  
Rosália S. Coutada ◽  
Soraia S. Cunha ◽  
Elisabete S. Gonçalves ◽  
Ana P. Gama ◽  
João P. Silva ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Pregnant Woman ◽  
Diabetic Ketoacidosis ◽  
Perinatal Mortality ◽  
Aggressive Treatment ◽  
Mortality And Morbidity ◽  
Threatening Condition ◽  
Life Threatening ◽  
In Pregnancy

Diabetic ketoacidosis in pregnancy is a rare but potential life-threatening condition for the mother and the fetus. It tends to occur latter in pregnancy and is more common in patients with pregestational diabetes. Obstetricians should be aware of the events that can trigger diabetic ketoacidosis in pregnancy. Prompt recognition and aggressive treatment of this condition are essential in order to reduce perinatal mortality and morbidity. The authors present a case of a pregnant woman with type 1 diabetes with a poor surveillance of pregnancy and noncompliance to treatment that develops severe diabetic ketoacidosis at 34 weeks of gestation.

scholarly journals Successful completion of pregnancy in a woman with chronic granulomatous disease

2011 ◽  
Vol 4 (4) ◽  
pp. 174-176 ◽  
Author(s):  
Michi Hisano ◽  
Shinichi Kobayashi ◽  
Naoko Arata ◽  
Atsuko Murashima ◽  
Koushi Yamaguchi
Keyword(s):  
Chronic Granulomatous Disease ◽  
Antimicrobial Prophylaxis ◽  
Granulomatous Disease ◽  
Successful Completion ◽  
Mortality And Morbidity ◽  
Threatening Condition ◽  
Life Threatening ◽  
Fatal Illness

Chronic granulomatous disease (CGD) used to be a fatal illness of childhood and patients rarely survived past the first decade. Although antimicrobial prophylaxis has dramatically reduced mortality and morbidity in recent years, CGD remains a life-threatening condition. We present the successful obstetric course of a patient with CGD.

scholarly journals Neonatal Purpura Fulminans

2014 ◽  
Vol 34 (1) ◽  
pp. 80
Author(s):  
D Sharma ◽  
J Yadav
Keyword(s):  
Purpura Fulminans ◽  
Severe Infection ◽  
High Morbidity ◽  
S Deficiency ◽  
Rapid Spread ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Gram Negative Organisms

Neonatal purpura fulminans is a rare, life-threatening condition of dermal microvascular thrombosis associated with DIC and perivascular hemorrhage in the newborn period associated with high morbidity and mortality [1]. Gram negative organisms and Staphylococcus species are the most common causes of the acute infectious type [2]. It may be congenital, as a result of protein C and S deficiency, or acquired due to severe infection. It is characterized by the rapid spread of symmetrical, bluish-black hemorrhages into the skin, affecting mainly the extensor surfaces of the extremities and showing a tendency to deep necrosis and the formation of sero-sanguineous bullae. The haemorrhagic areas are well defined and are surrounded by oedema. These lesions are accompanied by a high fever and intense systemic symptoms.DOI: http://dx.doi.org/10.3126/jnps.v34i1.8975 J Nepal Paediatr Soc 2014;34(1):80

Endovascular Embolization of Gastroduodenal Artery in its Pancreatogenous Arrosia: a Clinical Case

2019 ◽  
Vol 64 (6) ◽  
pp. 88-90
Author(s):  
M. Popov ◽  
S. Voskanyan ◽  
A. Dunaev ◽  
A. Bashkov ◽  
M. Aronov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Case ◽  
Pancreatic Pseudocyst ◽  
Pancreatic Head ◽  
Endovascular Embolization ◽  
Gastroduodenal Artery ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Vascular Structures

Arrosion of the peripancreatic vascular structures is a rare, but life-threatening condition and requires surgical treatment. One of the most common causes of arrosia is the presence of pancreatic pseudocyst. Imaging methods play a crucial role not only in terms of identifying the described pathology, but also in planning the tactics of surgical treatment. We present a clinical case of a patient, a 44-year-old male, with pseudocyst in the pancreatic head in the presence of chronic pancreatitis, complicated by bleeding into its cavity as a result of an arrosion of the gastroduodenal artery, which required endovascular embolization and drainage of the pseudocyst. This clinical case shows the possibility of endovascular embolization of the injured gastroduodenal artery with microspirals.

scholarly journals Endoscopic Management of Double Esophageal Perforation by Ingested Foreign Body Using Over-the-Scope Clip: A Case Report

2020 ◽  
Vol 11 (02) ◽  
pp. 153-155
Author(s):  
Prasanta Debnath ◽  
Pravin Rathi ◽  
Sujit Nair ◽  
Suhas Udgirkar ◽  
Sanjay Chandnani
Keyword(s):  
Case Report ◽  
Foreign Body ◽  
Pleural Effusion ◽  
Esophageal Perforation ◽  
Endoscopic Management ◽  
Esophageal Wall ◽  
Threatening Condition ◽  
Life Threatening ◽  
Ingested Foreign Body ◽  
Over The Scope Clip

AbstractEsophageal perforation is a life-threatening condition with a high mortality rate. First described around 300 years ago, management of this fatal condition has emerged from surgical to endoscopic modalities with much less morbidity and mortality when instituted early. We present this case of 55-year-old male, with double esophageal perforation by meat bone, perforating lower esophageal wall, leading to localized hydropneumothorax on right side with mild bilateral pleural effusion managed endoscopically with Over-the-Scope-Clip. Endoscopic management of esophageal perforation has been well mentioned in literature, without any mention of such management in case of double esophageal perforation. Surgery with or without endoscopy remains the main stay of management of such cases.

scholarly journals BIOMARKERS OF SEPSIS

JMS SKIMS ◽  
2017 ◽  
Vol 20 (1) ◽  
pp. 2-4
Author(s):  
Bashir Ahmad Fomda
Keyword(s):  
Altered Mental Status ◽  
Respiratory Alkalosis ◽  
Blood Stream ◽  
Rapid Progression ◽  
Microbial Invasion ◽  
Common Causes ◽  
Threatening Condition ◽  
Life Threatening ◽  
Definition Of ◽  
Infectious Source

“Sepsis is a state caused by microbial invasion from a local infectious source into the blood stream which leads to signs of systemic illness in remote organs,” this was the first scientific definition of sepsis proposed by Dr. Schottmuller in 1914.Sepsis is among the most common causes of death in hospitalized patients. Its death toll is in the same range as that of myocardial infarction. 1 Early and reliable diagnosis is imperative, because of the remarkably rapid progression of sepsis into a life-threatening condition.2 Findings in a patient with suspected or proven infection include fever or hypothermia, tachypnea, tachycardia, leukocytosis or leucopenia, acutely altered mental status, thrombocytopenia, an elevated blood lactate level, respiratory alkalosis, or hypotensions. 3  JMS 2017; 20(1):2-4

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