scholarly journals Endoluminal vacuum therapy in the management of an esophago-pleural fistula as a complication of Boerhaave syndrome in a patient with eosinophilic esophagitis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carlos Tuñon ◽  
Juan De Lucas ◽  
Jan Cubilla ◽  
Rafael Andrade ◽  
Miguel Aguirre ◽  
...  
Keyword(s):  
Eosinophilic Esophagitis ◽  
Chronic Inflammatory Disease ◽  
Vacuum Therapy ◽  
Esophageal Rupture ◽  
Case Presentation ◽  
Boerhaave Syndrome ◽  
Uncommon Condition ◽  
Fistula Treatment ◽  
Novel Strategy ◽  
Esophageal Perforations

Abstract Background Boerhaave syndrome is an uncommon condition that represents about 15% of all esophageal perforation. A subset of these patients has eosinophilic esophagitis, a chronic inflammatory disease of the esophagus, that carries a risk of perforation of about 2%. Esophageal perforations can rarely result in the development of an esophago-pleural fistula. Treatment of esophago-pleural fistula represent a challenge due to lack of high quality evidence and scarce reported experience. Endoluminal vacuum-assisted therapy could have a role in the management by using the same principle applied in external wounds which provide wound drainage and tissue granulation. Case presentation We report a unique case of a 24-year-old man with eosinophilic esophagitis complicated with an esophageal rupture who developed an esophago-pleural fistula and was successfully managed with a non-surgical approach using endoluminal vacuum-assisted therapy. To our knowledge this could be the first experience reported in a patient with eosinophilic esophagitis. Conclusion Endoluminal vacuum-assisted therapy might be an effective and novel strategy in patients with eosinophilic esophagitis and esophago-pleural fistula as a consequence of Boerhaave syndrome. Appropriately designed studies are required.

scholarly journals Delayed hypersensitivity reaction to orodispersible budesonide in a case with eosinophilic esophagitis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Caroline Michèle Andrist ◽  
Lukas Jörg ◽  
Thomas Greuter ◽  
Anna Gschwend ◽  
Alex Straumann ◽  
...  
Keyword(s):  
Hypersensitivity Reaction ◽  
Eosinophilic Esophagitis ◽  
Systemic Reaction ◽  
Chronic Inflammatory Disease ◽  
Delayed Hypersensitivity ◽  
Caucasian Woman ◽  
Case Presentation ◽  
Commercial Test ◽  
Delayed Hypersensitivity Reaction ◽  
Subsequent Intake

Abstract Background Eosinophilic esophagitis (EoE) is a chronic inflammatory disease that has been known since the early 1990s. Swallowed topical corticosteroids (STC) belong to the therapeutic cornerstones. We describe a delayed hypersensitivity reaction to Jorveza®, a newly developed orodispersible budesonide tablet licensed for the treatment of eosinophilic esophagitis. Case presentation A 32-year-old Caucasian woman with EoE was newly treated with Jorveza®. Hours after the first intake, she felt a “strange pruritus” in the throat. This sensation worsened with each subsequent intake. On day 4 she developed oral mucosal symptoms (paresthesia of the tongue, sore and an itchy throat). Intraoral, throat and facial swellings, but no systemic reaction were observed. Patch testing using two commercial test series as well as the orodispersible budesonide tablet revealed a strong sensitization, proving a T cell mediated allergy to budesonide. Conclusions Orodispersible budesonide is increasingly prescribed for the treatment of eosinophilic esophagitis. The development of oropharyngeal symptoms after initiating should alert the treating physician to the possibility of a hypersensitivity reaction.

scholarly journals INNOVATIVE DIAGNOSTIC METHODS FOR THE TREATMENT OF PATIENTS WITH BOERHAAVE SYNDROME AND ITS COMPLICATIONS

2021 ◽  
Vol 21 (4) ◽  
pp. 48-53
Author(s):  
К. G. Kubachev ◽  
В. A. Apereche ◽  
S M. Babaev
Keyword(s):  
Spontaneous Rupture ◽  
Diagnostic Methods ◽  
Vacuum Therapy ◽  
Esophageal Rupture ◽  
Treatment Results ◽  
Improve Treatment ◽  
Boerhaave Syndrome ◽  
Esophageal Stenting

Transluminal endoscopic interventions in the treatment of patients with spontaneous rupture of the esophagus can significantly improve treatment results. Esophageal stenting and vacuum therapy for the treatment of esophageal rupture and suture incompetence are alternatives to surgery.

Intermammary Hidradenitis Suppurativa: Considerations on a Unique Presentation

2021 ◽  
pp. 1-4
Author(s):  
Ana Luísa João ◽  
Nélia Cunha ◽  
Joana Cabete
Keyword(s):  
Surgical Approach ◽  
Inflammatory Disease ◽  
Pilonidal Sinus ◽  
Hidradenitis Suppurativa ◽  
Chronic Inflammatory Disease ◽  
Pilonidal Sinus Disease ◽  
Sinus Disease ◽  
Case Presentation ◽  
Overweight Women

Introduction: Hidradenitis suppurativa (HS) is a potentially disabling chronic inflammatory disease. The intermammary location, not clearly specified in the usual phenotypic classifications, entails significant functional and cosmetic compromise. Case Presentation: Eleven cases of predominantly intermammary disease with multiple fistulization and disfiguring scarring were observed at our Department between January 2016 and March 2020. They were young (mean age = 22 years) obese or overweight women, in which the medical-surgical approach has led to variable results. Discussion/Conclusion: Intermammary HS possibly represents a unique phenotypic presentation, likely to be fistulizing and severe. We believe that anatomo-functional considerations, which can be paralleled to pilonidal sinus disease, contribute to its pathophysiology and striking appearance, and further emphasize the importance of multidisciplinary endeavor to reduce the morbidity associated with this seemingly overlooked location.

scholarly journals Septic Pulmonary Embolism Secondary to Klebsiella pneumoniae Epididymitis: Case Report and Literature Review

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Juan Sebastián Alonso Ojeda Gómez ◽  
Jorge Alberto Carrillo Bayona ◽  
Laura Cristina Morales Cifuentes
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Circulation ◽  
Respiratory Symptoms ◽  
Unusual Complication ◽  
Chest Imaging ◽  
Case Presentation ◽  
History Of ◽  
Septic Pulmonary Embolism ◽  
Uncommon Condition ◽  
Acute Epididymitis

Background. Septic pulmonary embolism (SPE) is defined as the occurrence of septic thrombi in the pulmonary circulation. We report a case of SPE secondary to K. pneumoniae epididymitis. Case Presentation. A 74-year-old male with a history of diabetes mellitus experienced SPE secondary to epididymitis, with isolation of K. pneumoniae in blood and presence of lung nodules, with a chest computed tomography showing the halo and reversed halo signs. Discussion. SPE is characterized by the presence of septic thrombi in the pulmonary circulation coming from an extrapulmonary infective focus. SPE secondary to K. pneumoniae epididymitis is an uncommon condition that is characterized by the presence of multiple bilateral nodules of peripheral distribution. Conclusion. SPE is an unusual complication of acute epididymitis. Suspicion of SPE should be considered in patients with a diagnosis of epididymitis, respiratory symptoms, and multiple nodules in chest imaging assessments.

scholarly journals Endoluminal vacuum therapy of esophageal perforations

VideoGIE ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 8-10 ◽  
Author(s):  
Mustafa Abdulsada ◽  
Robert Jay Sealock ◽  
Lorraine Cornwell ◽  
Gyanprakash A. Ketwaroo
Keyword(s):  
Vacuum Therapy ◽  
Esophageal Perforations

P166 SPONTANEOUS ESOPHAGEAL RUPTURE – BOERHAAVE SYNDROME

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
B  Movchan ◽  
O Usenko ◽  
A Zgonnyk ◽  
R Vynogradov
Keyword(s):  
Spontaneous Rupture ◽  
Pleural Cavity ◽  
Clinical Manifestations ◽  
Esophageal Rupture ◽  
Esophageal Stents ◽  
Spontaneous Esophageal Rupture ◽  
Timely Diagnosis ◽  
Boerhaave Syndrome ◽  
Surgical Tactics ◽  
Effective Drainage

Abstract Aim To study the most effective method of treatment in patients with spontaneous rupture of the esophagus. Background The timely diagnosis of Boerhaave syndrome presents great difficulties due to its rarity, a variety of clinical manifestations, often simulating different pathologies from other organs and are difficult to treat. Methods From 2003 to 2019 9 patients with Bourhave's syndrome were treated at the clinic, primary care was provided to 6 patients in the community. All patients were admitted to the clinic with external left-sided esophageal-pleural fistula, 1 patient had a spontaneous rupture of the esophagus in the cliniс, the defect of the esophagus wall defect was completed, which led to successful results. Results Treatment in the remaining patients was started with adequate enteral nutrition and effective drainage of the pleural cavity. As a result of the use of pleural double-lumen drainage with active sanation with antiseptics and subsequent aspiration, with the exception of feeding through the mouth in four patients, it was possible to eliminate the esophageal-pleural fistula, profuse bleeding and death of the patient. Against the background of ongoing conservative therapy in two patients, it was not possible to eliminate the esophago-pleural fistula. A left-sided thoracotomy was performed with excision of the fistula with the decortication of the lung and the extirpation of the esophagus with the formation of an esophagostomy. Subsequently, these patients underwent retrosternal colic esophagoplasty. Two patients underwent Lewis surgery with drainage of the pleural cavity. Conclusion Boerhaave syndrome has a very high mortality rate, however, with a timely diagnosis and adequate surgical tactics, it develops into the formation of an esophageal-pleural fistula. In this case, the most effective treatment is excision of the fistulous course with extirpation of the esophagus and subsequent esophagoplasty. The use of esophageal stents is possible in extremely depleted patients or in elderly patients, due to the frequent occurrence of hypergranular esophagitis. Esophageal stents should be removed as soon as possible when confidence in the elimination of the esophageal-pleural fistula occurs.

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