Oesophageal perforation – therapeutic and diagnostics challenge. Retrospective, single-center case report analysis (2009–2015)

2017 ◽  
Vol 89 (4) ◽  
pp. 1-4 ◽  
Author(s):  
Piotr Misiak ◽  
Sławomir Jabłoński ◽  
Łukasz Piskorz ◽  
Lechosław Dorożała ◽  
Artur Terlecki ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Esophageal Perforation ◽  
Oesophageal Perforation ◽  
Esophageal Rupture ◽  
Single Center ◽  
Oncological Surgery ◽  
Clinical Value ◽  
Threatening Condition ◽  
Esophageal Prosthesis ◽  
Esophageal Perforations

Background: Esophageal perforation is a life-threatening condition of a complex etiology. No clear guidelines are available regarding the management of this condition. In this study, we review publications related to esophageal perforation, and analyze patients treated for this condition at our Department of Thoracic, General and Oncological Surgery. Objective: The objective of the study was to retrospectively assess and analyze management methods for esophageal perforations of different etiologies. All patients were treated in the Department of Thoracic, General and Oncological Surgery in years 2009-2015. Patients with perforations resulting from post-operational leaks within surgical anastomoses were excluded from the study. Material, methods, results: The analysis involved a total of 16 cases of esophageal ruptures. All cases were treated in years 2009-2015. Patients with perforations resulting from postoperative leaks within surgical anastomoses following elective surgeries for either oncological or non-oncological causes were excluded. The most common reason for esophageal rupture was iatrogenic injury (7 cases, 44%). Other causes included Boerhaave syndrome (5 cases, 31.2%), blunt trauma (2 cases, 12.5%), abscess perforation (1 case, 6.2%), and ulcer perforation (1 case, 6.2%). Ten patients underwent surgery, and the rest underwent esophageal prosthesis placement, of whom 2 cases required drainage of the mediastinum and pleural cavity. The mortality rate in the study group was 9/16 cases (56.2%). Conclusions: Esophageal perforation poses a significant interdisciplinary challenge regarding diagnostic workup, selection of treatment methods, and management of potential postoperative complications. This retrospective study was conducted in a single center. Although the analyzed period was long, we found only 16 cases. In spite of a variety of etiologies present, we found several statistically significant results of potential clinical value. 1. Most perforations that are not diagnosed within 48 hours affected the lower part of the esophagus and presented with unclear symptoms and imaging findings 2. Delaying diagnosis and treatment beyond 24 hours was associated with a higher mortality rate.

Melatonin reduces the mortality of severely-infected COVID-19 patients

2021 ◽  
Vol 4 (4) ◽  
pp. 613-616
Author(s):  
Dun-Xian Tan ◽  
Russel J Reiter
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Mortality Rate ◽  
Randomized Clinical Trial ◽  
Control Group ◽  
Mortality Reduction ◽  
Single Center ◽  
Open Label ◽  
Melatonin Treatment ◽  
The World

SARS-CoV-2 has ravaged the population of the world for two years. Scientists have not yet identified an effective therapy to reduce the mortality of severe COVID-19 patients. In a single-center, open-label, randomized clinical trial, it was observed that melatonin treatment lowered the mortality rate by 93% in severely-infected COVID-19 patients compared with the control group (see below). This is seemingly the first report to show such a huge mortality reduction in severe COVID-19 infected individuals with a simple treatment. If this observation is confirmed by more rigorous clinical trials, melatonin could become an important weapon to combat this pandemic.

599 MEDIASTINITIS SECONDARY TO ESOPHAGEAL PERFORATION: IT’S TOO LATE?

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Emanuele Russo ◽  
Mario Sorice ◽  
Luigi Busiello ◽  
Aniello Della Morte ◽  
Emilia Polimeno ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Esophageal Perforation ◽  
Multiple Organ ◽  
Oesophageal Perforation ◽  
Invasive Treatment ◽  
Emergency Thoracotomy ◽  
Risk Of Death ◽  
Single Center Experience ◽  
Empiric Antibiotic ◽  
Empiric Antibiotic Treatment

Abstract   Mediastinitis secondary to esophageal perforation is a rare, progressive, and destructive disease that may often lead to an imminent risk of death. We describe a single center experience showing how early diagnosis and prompt intervention can reduce mortality and complications. Methods From February 2016 to December 2019, 15 consecutive patients were referred to the Emergency Unit of The AORN Cardarelli (Naples) with clinical and radiological (CT scan) diagnosis of acute mediastinitis secondary to oesophageal perforation (post endoscopy or after foreign body ingestion) and furthermore, referred to the Thoracic Surgery Unit, they underwent to early surgical treatment (cervicotomy and\or thoracotomy and chest drainage. Results For early detected case (occurred within 24 hours) an emergency thoracotomy/cervicotomy was performed with surgical repair. For late detected (referred from other hospitals) a Surgical esclusion (abdominal plus cervical) and toilette thoracotomy was performed in emergency. Reconstruction occurred in 5 cases with a median of 46 days after firts care. All patient were admitted to ICU unit and susbsequentily to the thoracic surgery ward. 30 days mortality occurred in two cases. Median hospital staying was 28 days, in six cases a redo surgery was necessary. Empiric antibiotic treatment was started before operation and reviewed under Infectivologist. Conclusion Mediastinitis secondary to esophageal perforation has a fulminating course with a potential risk of sepsis, pericarditis, and multiple organ failure. A prompt identification and an invasive treatment is the best and most successful option to reduce mortality and improve patient’s recovery.

PS02.056: TIMELY LIGATION OF THORACIC DUCT IN POST ESOPHAGECTOMY CHYLE LEAK: KEY TO SUCCESSFUL MANAGEMENT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 136-136
Author(s):  
Sanjeev Parshad ◽  
Parvinder Sandu ◽  
Shekar Gogna ◽  
Abhijeet Beniwal ◽  
Rajendra Karwasra
Keyword(s):  
Mortality Rate ◽  
Thoracic Duct ◽  
Conflicts Of Interest ◽  
Surrounding Tissue ◽  
Chyle Leak ◽  
Threatening Condition ◽  
Life Threatening ◽  
Carcinoma Esophagus ◽  
Esophagectomy For Cancer

Abstract Background Chyle leak after esophagectomy for carcinoma esophagus is a rare but life threatening condition with reported an incidence of 1–6%. Mortality rate of up to 50% have been reported. Management of chyle leak is controversial. We reviewed our experience with iatrogenic chylothorax after esophagectomy for carcinoma esophagus. Methods From 2003 to 2017, 560 patients underwent esophagectomy for cancer at our department of oncosurgery. Eight patients developed post operative chyle leak. Transthoracic or transabdominal ligation of duct was done in six patients with in first week. 100 ml of cream was given 30 min before induction to visualize the leak intraoperatively. We used 4–0 prolene pledgeted suture to ligate the duct. Results Six patients who underwent early ligation could be salvaged and the two who were managed conservatively succumbed. Oringer et al. pointed towards conservative treatment having little place in the management of chylothorax in nutritionally depleted patients. Hence, prompt ligation of thoracic duct decreases morbidity and mortality of chylothorax. Thus the role of early surgery needs to stressed. There is a wide difference of mortality rate of conservative management of 82% with respect to the mortality rate of surgery of 10–16%. Though no conclusion data are available regarding the indication and time point of surgical ligation of the thoracic duct, it is important not to procrastinate while the condition deteriorates to a level at which surgery would be detrimental.Administration of cream to the patient (through feeding jejunostomy) around half an hour before surgery makes identification of site of leak simpler.The importance of pledgeted sutures cannot be denied as the thoracic duct is paper thin and chyle contains no fibrin. Thus non pledgeted sutures will tear it further. Infact, stitching should not be done through the duct but into the surrounding tissue around the duct and should allow the pledgets to close the duct. Conclusion Disclosure All authors have declared no conflicts of interest.

Low Mortality After Treatment for Esophageal Perforation: A Single-Center Experience

2010 ◽  
Vol 90 (5) ◽  
pp. 1669-1673 ◽  
Author(s):  
W. Brent Keeling ◽  
Daniel L. Miller ◽  
Geoffrey T. Lam ◽  
Pat Kilgo ◽  
Joseph I. Miller ◽  
...  
Keyword(s):  
Esophageal Perforation ◽  
Single Center ◽  
Single Center Experience

Outcome of stent grafting for esophageal perforations: single-center experience

2017 ◽  
Vol 31 (9) ◽  
pp. 3696-3702 ◽  
Author(s):  
Fausto Biancari ◽  
Tuomas Tauriainen ◽  
Tatu Ylikotila ◽  
Misa Kokkonen ◽  
Jukka Rintala ◽  
...  
Keyword(s):  
Single Center ◽  
Stent Grafting ◽  
Single Center Experience ◽  
Esophageal Perforations

scholarly journals Diagnostic challenge and surgical management of Boerhaave’s syndrome: three diagnosed cases of spontaneous esophageal rupture

2020 ◽  
Author(s):  
Jiayue Wang ◽  
Degang Wang ◽  
Jianjiao Chen
Keyword(s):  
Pleural Effusion ◽  
Early Diagnosis ◽  
Physical Examination ◽  
Ct Scan ◽  
Medical History ◽  
Subcutaneous Emphysema ◽  
Esophageal Perforation ◽  
Esophageal Rupture ◽  
Boerhaave’S Syndrome ◽  
Boerhaave's Syndrome

Abstract BACKGROUND: Boerhaave’s syndrome is the spontaneous rupture of the esophagus, caused by an increase of intraluminal pressure that is produced in the context of negative intrathoracic pressure. It has a high index of morbimortality, which is why it requires early diagnosis and treatment. Symptoms may vary, and diagnosis can be challenging.CASE PRESENTATION: Case one: A 54-year-old man presented to us with sudden-onset epigastric pain radiating to the back following hematemes. His previous medical history included gastric ulcer. His physical signs suggested early shock. Combined with his medical history and physical signs, emergency doctor suspected a diagnosis of peptic ulcer with hematemesis, and esophagegastroscopy was performed. However, upper gastrointestinal endoscopy revealed a full-thickness rupture of the esophageal wall. The subsequent computed tomography (CT) showed frank pneumomediastinum and heterogeneous pleural effusion. He was subsequently referred to us in view of suspected Boerhaave’s syndrome and clinical worsening. In view of hemodynamic instability with uncontrolled sepsis, he was planned for surgery. Esophageal perforation repair operation and jejunostomy was performed for him. The postoperative period was uneventful, and he was discharged.Case two: A 62-year-old man was admitted to the emergency department with thoracic dull pain and chest distress that started after he had been vomiting several hours before presentation. On physical examination, he presented rough bronchovesicular breathing sound, and crepitant rales in lungs prompting subcutaneous emphysema. Chest CT scan showed pneumomediastinum and large left-sided pleural effusion. Esophagus fistula was confirmed by contrast esophagography. Therefore, spontaneous esophageal perforation was suspected. Then, we performed thoracotomy to repair the esophageal tear as well as to debride and irrigate the left pleural space. His vital signs remained stable intraoperatively, and his postoperative periods were uneventful with no leakage or stricture. Case three: The patient was a 69-year old male presenting with a severe retrosternal and upper abdominal pain followed an episode of forceful vomiting. At admission, he was diaphoretic and in respiratory distress. Physical examination revealed extensive cervical and thoracic subcutaneous emphysema but was otherwise unremarkable. A thoracic CT scan revealed a rupture in the left distal part of the oesophagus, a pneumomediastinum and left-sided pleural effusions. Conservative treatment, with cessation of oral intake, nasogastric suction, administration of intravenous fluids and parenteral nutrition, intravenous broad-spectrum anti-biotics, proton pump inhibitors and drainage of the pleural effusion by left-sided thoracostomy, failed to improve disease conditions. Open thoracic surgery was performed with debridement and drainage of the mediastinum and the pleural cavity, after which he made a slow but full recovery.CONCLUSIONS: We highlight that early diagnosis and appropriate surgical treatment are essential for optimum outcome in patients with esophageal rupture. We emphasize the importance of critical care support, particularly in the early stages of management.

scholarly journals #32: Single Center Experience with the Use of Convalescent Plasma Transfusion (CPT) for COVID-19 + Patients in Argentina

2021 ◽  
Vol 10 (Supplement_2) ◽  
pp. S18-S19
Author(s):  
Sergio Miguel Gómez
Keyword(s):  
Side Effects ◽  
Mortality Rate ◽  
Median Time ◽  
Chronic Obstructive Lung Disease ◽  
Categorical Variables ◽  
Chronic Obstructive ◽  
Single Center ◽  
Plasma Therapy ◽  
Single Center Experience ◽  
Day Range

Abstract Background COVID-19 pandemic challenged health sanitary systems worldwide. 1.65 million cases have been reported in Argentina with 43.635 deaths. CPT emerged as a possible and feasible treatment. Transfusion cardiovascular overload (TACO), acute lung injury (TRALI) and anaphylactic reactions (AR) have raised safety concerns; in the other hand, it is still unknown its efficacy but preliminary reports have claimed that if it is delivered early, mortality or morbidity could be decreased. Pediatric use of CPT is emerging from adults’ studies. Objective To review clinical outcomes, laboratory parameters and side effects of CPT in a single center in Argentina and determine the mortality rate. Methods This is a single-center single-arm exploratory-descriptive prospective study, starting on May 1, 2021 until October 31, 2021. A protocol developed for donation of CPT included those individuals with SARS-CoV-2 RT- PCR positive in respiratory secretions and SARS-CoV-2 antibody positive by immunochromatography o chemiluminescence, with a titer by ELISA (Covidar®) > 1:400 and 200 – 250 mL were considered 1 Unit. Recipients weighing <70 kg received 1 unit, and those recipients weighing >70kg received 2 units. CPT was prescribed within 14 days of starting SARS-CoV-2 symptoms. All patients received dexamethasone and standard support measures. We used percentages and frequencies for reporting the results of this study. Categorical variables were compared with Chi2 and numeric Fisher/Mann Whitney. Time dependent survival variables were calculated with Kaplan Meier method. SPPS 20 software was used for data processing. Results The CPT recipients median age (IQR) was 47 years of age (range 43–59 years); 65.5 % were; 12,5% had either hypertension or obesity, 3.1% chronic obstructive lung disease; 30% had diabetes. The median temperature at diagnosed was (IQR) 37.7°C (range 36.6°C - 38.9°C). A total of 39 CPT units were infused in 32 patients. 25 patients (78%) received 1 unit, 6 patients (19%) received 2 units and 1 patient (3%) received 3 units (3%). Donor median (IQR), SARS-CoV-2 antibody titer was 1:400 (range 400–1600); median time (IQR) to transfusion was 1 day (range 1–4). Coverage was 100%. Outcomes 29 patients (91%) survived and 3 (9%) died for COVID-19. Only 3 patients (8%) developed moderate/reversible side effects: allergic reaction (2 pts) and TRALI(1pt) At a median time of 100 days, the median survival was 85% (0.5) and the mortality rate was 19 % (0.6). Laboratory features: Conclusion CPT was feasible to deliver and could be implemented in a less resourced country in a timely fashion. All our patients could afford plasma therapy. No severe adverse events were reported. Pediatric studies can be based on the results of this type of study. Research should focus now on a control case cohort study to determine efficacy of CPT.

scholarly journals Oral booster probiotic bifidobacteria in SARS-COV-2 patients

2021 ◽  
Vol 35 ◽  
pp. 205873842110596
Author(s):  
Hüseyin S Bozkurt ◽  
Ömer Bilen
Keyword(s):  
Mortality Rate ◽  
Length Of Stay ◽  
Treatment Strategy ◽  
Single Center ◽  
Single Strain ◽  
Probiotic Group ◽  
Single Center Study ◽  
Potential Strategy ◽  
Center Study

Oral booster-single strain probiotic bifidobacteria could be a potential strategy for SARS-CoV-2. This study aims to evaluate the role of oral probiotic Bifidobacterium on moderate/severe SARS-CoV-2 inpatients. In this single-center study, we analyzed data of 44 moderate/severe inpatients with diagnosed COVID-19 in Istanbul Maltepe University Medical Faculty Hospital, 2020 from 1 November 2020 to 15 December 2020. Clinical and medication features were compared and analyzed between patients with or without probiotic. In result, 19 of the 44 patients (43.18%) who were administrated with oral booster-single strain probiotic were discharged with the median inpatient day of 7.6 days which were significantly shorter than those of patients without probiotic. There were significant differences in inpatient days, radiological improvement at day 6 and week 3, and reduction in interleukin-6 levels in those receiving oral probiotic therapy. Although the mortality rate was 5% in the probiotic group, it was 25% in the non-probiotic group. Booster-single strain probiotic bifidobacteria could be an effective treatment strategy for moderate/severe SARS-CoV-2 inpatients to reduce the mortality and length of stay in hospital.

scholarly journals The first two months of COVID-19 pandemic in Bosnia and Herzegovina: Single-center experience

2020 ◽  
Author(s):  
Jurica Arapović ◽  
Siniša Skočibušić
Keyword(s):  
Mortality Rate ◽  
Severe Acute Respiratory Syndrome ◽  
Bosnia And Herzegovina ◽  
The Novel ◽  
Single Center ◽  
Single Centre ◽  
Single Center Experience ◽  
Single Centre Experience ◽  
Novel Coronavirus ◽  
The University

The novel coronavirus disease 2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is still progressing and has been recorded in more than 210 countries and territories worldwide. In Bosnia and Herzegovina, the first cases of COVID-19 were detected on 5th of March 2020 in the entity of Republic of Srpska and 9th of March 2020 in the entity of Federation of Bosnia and Herzegovina. Up until the 16th of May 2020, more than 2,200 COVID-19 cases were recorded in both entities, with a mortality rate of 5.8% (131 out of 2231 cases). The aim of this ongoing study is to present the current epidemiological and sociodemographic parameters of 380 COVID-19 patients diagnosed at the University Clinical Hospital Mostar (UCH Mostar) during the first two months of the COVID-19 pandemic. Out of 380 patients, 60 (15.8%) of them required hospitalization. The mortality rate was 5% (19/380). The highest mortality rate of 15.2% (12/79) was recorded in the patients age ≥65 years. In addition to this single-centre experience of the ongoing COVID-19 pandemic, we discuss the epidemiological measures imposed in Bosnia and Herzegovina, with emphasis on the restrictive ones. The COVID-19 pandemic is still ongoing in Bosnia and Herzegovina.

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