Unpredictable Outcome of Large Traumatic Oesophageal Injury: An Experience and Challenges

Oesophageal injury following blunt or penetrating injury due to road traffic accidents is a rare cause of morbidity and mortality. The outcome of delayed diagnosis of oesophageal injury is mostly life threatening conditions. A 23-year-old female presented with respiratory distress, fever, chest pain and facial deformity, following road traffic accident 15 days back. After evaluation, the patient was diagnosed with septicaemia due to large thoracic oesophageal perforation with left pyothorax. The patient was managed by Video Assisted Thoracoscopic Surgery (VATS) decortication with feeding jejunostomy followed by diversion cervical oesophagostomy. The patient was planned for oesophageal reconstructive surgery electively in follow-up period. After six weeks in the follow-up period, surprisingly large thoracic oesophagus perforation and cervical oesophagostomy was healed spontaneously which was confirmed by gastrograffin study. Spontaneous closure of large thoracic oesophageal perforation is the rare outcome of this injury.

Swallowed dentures in thoracic oesophagus

Oesophagus is the second most (46.8%) common site of impaction of foreign body in the gastro-intestinal tract. Dentures constitute the 3rd most common (2.4%) foreign body in oesophagus of adults, following meat bone (76.1%) and coin (3.6%).In our Institute, impacted dentures in esophageal are referred to our department after a failed endoscopic venture at removal by ENT surgeons. Extraction in such a situation calls for judicial planning and careful timing of the procedure to achieve satisfactory results. The present study was done on 11 cases of thoracic oesophageal dentures which were removed surgically in the Department of CTVS Medical College and Hospital, Kolkata over 2 years of period. Between 1st October 2017 to 30st September 2019, 11 dentures were extracted from thoracic oesophagus via right postero-lateral thoracotomy approach. The defect in the oesophagus after denture removal was primarily closed; with reinforcement using intercostals muscle pedicled flap. A defunctioning cervical oesophagostomy and a feeding jejunostomy (FJ) were done in all cases. Surgical leaks were noted in 5 cases, of which 1 lady had fulminant mediastinitis before she died. Pneumonia was observed in 4 cases, superficial surgical wound infection in 2 cases, blocked FJ tube in 1 case and leakage following closure of cervical oesophagostomy in 3 cases. Thoracic esophageal dentures are serious surgical entities which need early diagnosis and management. Pre-operative optimization is very important for avoiding surgical leakage.

An Innovative Technique to Repair Cervical Oesophageal Perforation using Oro-oesophageal Tube and AMBU

Introduction Oesophageal perforation is a rare condition and has high morbidity and mortality. Both the morbidity and mortality are directly related to the delay in diagnosis and start of treatment. Primary closure with drainage is recommended if perforation is detected in less than 24 hours. Treatment for delayed or missed rupture of oesophagus is not very clear and is controversial. Case Report We hereby report a case of delayed diagnosed cervical oesophagus rupture following gunshot, which was primarily repaired. Special emphasis is on newer technique of fistula localization using oro-oesophageal tube and AMBU for better closure. The fistula closure was successful and no there were no post-operative complications. Discussion The symptoms and signs on presentation of patient of cervical oesophagus perforation are discussed along with the differing treatment paradigms for early versus late presentation. Surgical repair with primary closure may be undertaken, even in late presentation of oesophagus rupture. This technique of oro-oesophageal tube used along with AMBU, may be useful in cases of both cervical and upper thoracic oesophagus rupture.

Analysis of Treatment Results of the Thoracic Part of Oesophageal Cancer

AIM: This study aims to evaluate the methods of treatment of the thoracic part of oesophagal cancer and to predict the results of treatment depending on the factors of the prognosis. MATERIALS AND METHODS: The results of treatment of 366 patients with cancer of the thoracic part of the oesophagus for 10 years (2007-2016) by the department of thoracic oncology of the Karaganda oncological dispensary were studied. RESULTS: The overall five-year survival rate, regardless of the method of treatment, was only 8.72% (28 of 321), and in the 6-10 year period 8.41% (27 of 321) lived, p < 0.05. Analysis of the overall survival of patients with cancer of the thoracic part of oesophagus showed that the method of treatment does not have a significant effect on life expectancy. A multivariate analysis of 19 grades that affect the prognosis of the disease was carried out. CONCLUSION: Radical type of treatment of the middle and lower thoracic oesophagus is surgical, in which the median of cumulative survival is 19 months. Traditional radiotherapy should be used in a limited way, as it is palliative, with a median survival of no more than 9 months. The leading factor in the prognosis for thoracic part of oesophagal cancer is the presence of regional metastases, on which the choice of method of treatment depends.

Yellowish lesions in the oesophagus

Clinical presentationA 51-year-old man, who had no previous disease, underwent a screening oesophagogastroduodenoscopy, which revealed multiple yellowish lesions in the middle thoracic oesophagus. All lesions were ≤3 mm in size and slightly elevated. Each lesion showed one or two white protrusions on the surface (figure 1). We observed that one lesion looked obviously different from the others and showed yellowish granular spots (figure 2). A biopsy was performed on a representative lesion among the slightly elevated yellowish lesions with white protrusions (figure 3). A biopsy was repeated on a lesion showing yellowish granular spots (figure 4). Blood tests which were examined on the same day, including triglyceride and cholesterol, were within normal limits. Figure 1Slightly elevated yellowish lesions with white protrusions in the middle thoracic oesophagus.Figure 2A lesion showing yellowish granular spots in the middle thoracic oesophagus.QuestionWhat is the diagnosis?