1/54. Unusual site for oesophageal perforation in an extremely low birth weight infant.A male infant born at 26 weeks gestation became unwell at 10 days of age with blood-stained pharyngeal aspirates. The chest radiograph revealed a feeding tube in the right pleural cavity, indicating a perforation of the thoracic oesophagus. The infant had had a chest drain inserted on the right side on two previous occasions. These had been allowed to remain across the mediastinum at the site of the subsequent perforation. The infant was successfully managed conservatively with no long-term sequelae The unusual site of the perforation led us to conclude that pressure necrosis from the drains was a contributing factor in the aetiology. CONCLUSION: Oesophageal perforations in the neonate, in contrast to the adult, can be managed conservatively.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/54. Perforated epiphrenic diverticulum treated by video laparoscopy.We describe the case of an esophageal perforation that occurred after an endoscopic examination for epigastric pain 11 days before being referred to our institution. After 5 days of conservative management with total parenteral nutrition, left chest drainage, and broad-spectrum antibiotics, we decided to perform an videolaparoscopic jejunostomy for feeding with distal esophageal exclusion and a cervical esophagostomy. In the operating room, however, we found that the site of the perforation was an epiphrenic diverticulum. Treatment was diverticulectomy through videolaparoscopy with manual and mechanic suture. The postoperative evolution was successful, and the patient was discharged 8 days after surgery.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
3/54. Pleural empyema: An unusual presentation of esophageal perforation.A 67-year-old patient presented with pleural empyema as the sole manifestation of thoracic esophageal perforation, 2 weeks after accidental fish bone ingestion. Nonspecific chest pain and general deterioration, unusual presenting symptoms in themselves, accounted for the extreme delay in the diagnosis. The empyema was treated surgically, and the esophageal perforation conservatively. Despite the poor prognostic factors, the patient recovered completely after 50 days in hospital.- - - - - - - - - - ranking = 4.912889854963keywords = chest pain, chest (Clic here for more details about this article) |
4/54. Right-sided pleural effusion in spontaneous esophageal perforation.Spontaneous esophageal perforation (Boerhaave's syndrome) is a rare clinical entity in which overindulgence in a large meal precedes vomiting and chest pain. early diagnosis and aggressive management are keys to minimizing the morbidity and mortality. We report an unusual presentation of this already uncommon occurrence in a 33-year-old female. She presented to the Emergency Department with severe chest pain following vomiting with hematemesis after a large meal. The initial chest radiograph showed up nothing in particular. dyspnea developed two days later, and a right-sided pleural effusion was seen on chest x-ray. Panendoscopy was highly suggestive of Boerhaave's syndrome. She underwent emergency operation. After three months of hospital care, she was discharged in relatively good condition. This case of right-sided pleural effusion extends the reported description of Boerhaave's syndrome.- - - - - - - - - - ranking = 10.825779709926keywords = chest pain, chest (Clic here for more details about this article) |
5/54. Respiratory distress due to esophageal perforation caused by ball point ingestion.A 15-month-old girl who developed respiratory distress which persisted for three days prior to admission demonstrated pleural effusion on the chest x-ray which was determined to be due to esophageal perforation caused by the ingestion of a ball point. A gastrotomy was performed to extract the ball point. A gastrostomy was performed and a chest tube was inserted. The esophagus was normal radiologically within one month. Foreign body ingestion may cause esophageal perforation in childhood. If it goes unnoticed and a diagnosis is delayed, there is danger of the more hazardous development of mediastinitis. It is important that a child with respiratory distress also be evaluated for esophageal foreign body ingestion.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
6/54. Successful nonoperative management of delayed spontaneous esophageal perforation in patients with human immunodeficiency virus.OBJECTIVE: To describe the clinical outcome of esophageal stenting for repair of distal esophageal perforation in one patient with septic shock and human immunodeficiency virus. DESIGN: Case report. SETTING: Medical-surgical intensive care units of one university teaching hospital. PATIENT: One patient with human immunodeficiency virus infection and septic shock in whom there was a delay in diagnosis of spontaneous perforation at the distal thoracic esophagus. INTERVENTION: A 10 cm x 2 cm silicone lined, partially coated, expandable metal stent was fluoroscopically placed in the distal esophagus at the perforation. Other treatment included chest tube thoracostomy, sump drainage of proximal esophagus, percutaneous gastrostomy, and antibiotics. MEASUREMENT AND MAIN RESULTS: Septic shock and the distal esophageal perforation were successfully treated with combined esophageal stenting, thoracostomy pleural drainage and antibiotics. Esophageal stenting was accomplished fluoroscopically with a partially coated, silicone-lined, expandable metal stent. CONCLUSION: Esophageal stenting, tube thoracostomy drainage, and antibiotics may be a management option for gravely ill patients with human immunodeficiency virus, esophageal perforation, and a delay in diagnosis. An optimal outcome requires a thoughtful, individualized approach and adherence to basic principles.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
7/54. Traumatic pharyngeal pseudodiverticulum in neonates and infants. Two case reports and review of the literature.Thirty one cases of pharyngeal pseudodiverticulum have been reported in the literature; twenty nine were diagnosed during the neonatal period. Respiratory distress, increased oral secretions, difficulty with feeding and the impossibility of passing a nasogastric catheter were the most common symptoms and/or signs. Pneumomediastinum, pneumothorax, cervical emphysema and ectopic location of a feeding catheter, alone or in combination, were identified in the chest roentgenograms of 16 patients. Esophagography and/or endoscopy were the diagnostic methods of choice. The exact location of the perforation was identified in 18 patients. Most of the perforations were in either the posterior pharyngeal wall or in the pyriform sinuses. The survival rate was as good amongst the medically treated patients as in those who underwent surgery.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
8/54. Esophageal intramural pseudodiverticulosis associated with esophageal perforation.We report a rare case of esophageal intramural pseudodiverticulosis with lower esophageal stricture which perforated into the peritoneal cavity after the patient vomited. A 61-year-old man was admitted with severe chest and epigastric pain after dysphagia and vomiting. Under a diagnosis of upper gastrointestinal perforation, laparotomy was performed. The anterior wall of the abdominal esophagus was found to have ruptured, and proximal gastrectomy with abdominal esophagectomy was performed. Histological examination revealed esophageal intramural pseudodiverticulosis with esophageal stricture distal to the site of rupture, and postoperative endoscopy showed diffuse pseudodiverticulosis in the remaining esophagus. The patient is free of symptoms 5 years after the surgery. This case suggests that careful treatment may be indicated in patients with esophageal intramural pseudodiverticulosis with stricture and elevated intraluminal pressure, to minimize the possibility of severe complications such as esophageal perforation.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
9/54. esophageal perforation associated with profound shock successfully managed with hemodynamic assistance using percutaneous cardiopulmonary support.A 51-year-old man was admitted to our hospital with complaints of severe chest pain, nausea, and vomiting. These symptoms had progressed rapidly and he was in shock. It was necessary to make a correct diagnosis as early as possible. However, the hemodynamic condition of the patient deteriorated rapidly before a definitive diagnosis could be established in spite of conventional therapies. Under hemodynamic assistance with percutaneous cardiopulmonary support (PCPS), a final diagnosis of esophageal perforation was made by esophagography. Our report illustrates a new application of PCPS for highly selected cases of noncardiogenic shock as a "bridge" until an accurate diagnosis is made and a specific treatment is applied.- - - - - - - - - - ranking = 4.912889854963keywords = chest pain, chest (Clic here for more details about this article) |
10/54. An atypical presentation of spontaneous pneumomediastinum.Spontaneous pneumomediastinum is a rare condition and a most uncommon complication of sporting activity. We describe a case of spontaneous pneumomediastinum in a 17-year-old boy while playing football with no history of blunt trauma to the chest. The patient presented with symptoms and signs suggestive of an oesophageal perforation. The importance of correct investigations and subsequent management are discussed.- - - - - - - - - - ranking = 0.5keywords = chest (Clic here for more details about this article) |
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