1/6. esophageal perforation associated with noninvasive ventilation: a case report.Noninvasive positive-pressure ventilation (NIPPV) is widely used to treat acute respiratory failure, the goal being to avoid exposing patients to the morbidity associated with tracheal intubation. NIPPV may reduce the rates of intubation, morbidity, and mortality in selected patient subgroups. Although time-consuming for physicians and nurses, NIPPV is fairly easy to use, and few severe complications have been reported. esophageal perforation is a well-recognized complication of tracheal intubation but has not been described in association with NIPPV. We report a case of fatal esophageal perforation associated with NIPPV after a surgical procedure.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Delayed presentation of oesophageal perforation simulating intrathoracic malignancy.We report two patients with silent oesophageal perforation. In neither patient was the diagnosis made preoperatively by the referring physicians and a history of swallowing difficulty was elicited in only one patient. The appearances on computed tomography were very similar in both patients: there was a soft tissue mass in the upper retro-oesophageal region with destruction of the underlying vertebral body.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. esophageal perforation associated with the esophageal obturator airway.The esophageal obturator airway (EOA) has been approved since 1973 as an adjunct for artificial ventilation. Description of the tube and contraindications to its use are presented. The two primary complications are tracheal intubation and esophageal perforation. A case report of esophageal perforation after EOA use is presented and a brief review of the previously reported cases is correlated with this case report. The true incidence of this complication has never been accurately studied but estimates vary between 0 and 2%. Possible factors contributing to this complication are discussed and recommendations regarding proper inflation are given. Because early diagnosis and treatment is essential, helpful historical, clinical, and radiographic findings that are presented should help to increase the index of suspicion of this complication. Increased familiarity with the EOA by physicians in the emergency department and the ICU is also necessary for early diagnosis and treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. esophageal perforation caused by coin ingestion.esophageal perforation and acquired tracheoesophageal fistulae (ATEF) are rare sequelae of foreign body ingestion in the pediatric population. Here we discuss the cases of two patients with esophageal perforation caused by prolonged impaction of a coin; in one case, a tracheoesophageal fistula developed. The presence of aerodigestive symptoms and signs in infants and small children should prompt physicians to consider foreign body ingestion and the presence of an ATEF. Clinical presentation, diagnostic modalities, and technical considerations for surgical management are outlined.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. Intrapleural placement of a nasogastric tube: an unusual complication of nasotracheal intubation.PURPOSE: Although rare, the misplacement of nasogastric tubes into the pleural space has been described. The prognosis of such injuries is improved by prompt recognition; therefore, it is important for physicians who practice nasogastric intubation to be aware of this potential complication, and to be familiar with an approach to early diagnosis. CLINICAL FEATURES: We present a case of perforation of the cervical oesophagus by a polyvinylchloride nasogastric tube, following a traumatic attempt at nasotracheal intubation. This resulted in passage of the nasogastric tube into the pleural space. CONCLUSIONS: Our experience with this case and a review of the relevant literature suggest that such trauma may predispose to malplacement of nasogastric tubes. Clinical signs, such as aspiration of fluid from a nasogastric tube, and auscultation of air insufflated into the stomach, are unreliable; however, the presence of subcutaneous air in the neck on chest radiograph, and the presence of cervical crepitance on physical examination, are valuable signs in the early diagnosis of perforation of the cervical oesophagus. Contrast oesophagography remains the diagnostic manoeuvre of choice in confirming the diagnosis, but early diagnosis will depend on a high index of suspicion and prompt viewing of chest x-rays. The management and the prognosis of such injuries depends on the level of the perforation, delays in diagnosis, and the presence of associated mediastinitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. Descending cervical mediastinitis.Descending cervical mediastinitis is an uncommonly reported presentation of infection originating in the head or neck and descending into the mediastinum, which is fraught with impressive morbidity and mortality rates of 30% to 40% or more. We present the INOVA-Fairfax-Alexandria Hospital experience with descending cervical mediastinitis, January 1, 1986, to April 1, 1997; in addition we review the English-language medical and surgical literature with regard to this entity. Computed tomography and magnetic resonance imaging serve to aid both diagnosis and management. The application of broad-spectrum antibiotics should initially be empiric, with an eye to coverage of mixed aerobic and anaerobic infections. Definitive treatment mandates early and aggressive surgical intervention. All affected tissue planes, cervical and mediastinal, must be widely debrided, often leaving them open for frequent packing and irrigation. The treating physician must remain always alert to the further extension of infection, which, if it occurs, must be further debrided and drained. tracheostomy serves a dual role of further opening cervical fascial planes and securing an often compromised airway.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |