A 71-year-old man presented with a productive cough and fever, and he was diagnosed as having an esophageal perforation and a mediastinal abscess. He had a history of traumatic hemothorax and pleural drainage for empyema in the right chest and was considered unable to tolerate thoracic surgery because of sepsis and progressive aspiration pneumonia. In order to aggressively drain the mediastinal contamination, we performed internal drainage by placing a Levin tube into the mediastinum through the perforation site. This procedure, in conjunction with controlling sepsis and providing sufficient postpyloric nutrition, allowed the esophageal injury to completely heal.
Abscess ; Aged ; Cough ; Drainage* ; Empyema ; Esophageal Perforation* ; Fever ; Hemothorax ; Humans ; Mediastinitis ; Mediastinum ; Pneumonia, Aspiration ; Sepsis ; Thoracic Surgery ; Thorax

A 71-year-old man presented with a productive cough and fever, and he was diagnosed as having an esophageal perforation and a mediastinal abscess. He had a history of traumatic hemothorax and pleural drainage for empyema in the right chest and was considered unable to tolerate thoracic surgery because of sepsis and progressive aspiration pneumonia. In order to aggressively drain the mediastinal contamination, we performed internal drainage by placing a Levin tube into the mediastinum through the perforation site. This procedure, in conjunction with controlling sepsis and providing sufficient postpyloric nutrition, allowed the esophageal injury to completely heal.
Abscess ; Aged ; Cough ; Drainage* ; Empyema ; Esophageal Perforation* ; Fever ; Hemothorax ; Humans ; Mediastinitis ; Mediastinum ; Pneumonia, Aspiration ; Sepsis ; Thoracic Surgery ; Thorax

OBJECTIVE: To evaluate the safety and prognosis for patients with early esophageal cancer and precancerous lesions after endoscopic submucosal dissection (ESD).
 METHODS: A total of 89 patients were admitted to the Department of internal medicine in the First People's Hospital of Anqing from August 2008 to August 2011. All patients were treated with ESD at the early stage of esophageal cancer and precancerous lesions. The patients' laboratory data and relevant medical history were collected. The postoperative complications and long-term effects of ESD were analyzed.
 RESULTS: Eighty-nine patients were followed up with 100% response rate. Among 89 cases, 16 were early esophageal cancer, 38 were high-grade esophageal neoplasia and 35 were low-grade esophageal neoplasia. The one-time whole piece resection rate, complete resection rate and curative resection rate was 93.3% (84/89), 92.1% (82/89) and 92.1% (82/89), respectively. Two cases suffered intraoperative perforation with a rate of 2.2% and these 2 patients performed the intraoperative endoscopic repair; one case suffered the postoperative delayed bleeding with a rate of 1.1% and the patient underwent the conservative treatment; three cases suffered the esophageal stenosis with a rate of 3.4%. All patients were followed-up for 10-58 (36.3±21.2) months. In this period, one case recurred after ESD for 3 years with a rate of 1.1%; two cases were dead. The three-year survival rate was 97.8%.
 CONCLUSION The early esophageal cancer and precancerous lesions can be treated with ESD. The method is safe and the prognosis is good.
Dissection ; Endoscopy ; adverse effects ; Esophageal Neoplasms ; surgery ; Esophageal Perforation ; Esophageal Stenosis ; Humans ; Postoperative Complications ; Postoperative Hemorrhage ; Prognosis

BACKGROUND/AIMS: Endoscopic resection (ER) of superficial esophageal neoplasm (SEN) is a technically difficult procedure. We investigated the clinical outcomes of ER for SEN to determine its feasibility and effectiveness. METHODS: Subjects who underwent ER for SEN at Asan Medical Center between December 1996 and December 2010 were eligible. The clinical features of patients and tumors, histopathological characteristics, adverse events, ER results and survival were investigated. RESULTS: A total of 129 patients underwent ER for 147 SENs. En bloc resection (EnR) was performed in 118 lesions (80.3%). Complete resection (CR) was accomplished in 128 lesions (86.5%), and curative resection (CuR) was performed in 118 lesions (79.7%). The EnR, CR, and CuR rates were significantly greater in the endoscopic submucosal dissection group when compared to those in the endoscopic resection group. Adverse events occurred in 22 patients (17.1%), including bleeding (n=2, 1.6%), perforation (n=12, 9.3%), and stricture (n=8, 6.2%). Local tumor recurrence occurred in 2.0% of patients during a median follow-up of 34.8 months. The 5-year overall and disease-specific survival rates were 94.0% and 97.5%, respectively. CONCLUSIONS: ER is a feasible and effective method for the treatment of SEN as indicated by favorable clinical outcomes.
Aged ; Aged, 80 and over ; Disease-Free Survival ; Dissection/*adverse effects/methods ; Esophageal Neoplasms/pathology/*surgery ; Esophageal Perforation/epidemiology/etiology ; Esophageal Stenosis/epidemiology/etiology ; Esophagoscopy/*adverse effects/methods ; Female ; Gastric Mucosa/surgery ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/epidemiology ; Postoperative Hemorrhage/epidemiology/etiology ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To discuss the diagnosis and treatment of esophageal perforation induced by esophageal foreign body. METHOD: Ten patients, who were diagnosed as esophageal foreign body and esophageal perforation, were retrospectively analyzed. One patient was operated in other hospital and transferred to our department post-operation. The foreign bodies were removed through rigid esophagoscope in 7 cases and through the tracheotomy in 1 case. The last case was admitted into hospital for abscess around the esophagus. The foreign body wasn't find during the examination of rigid esophagoscope and the patient vomited out a glass foreign body after the surgery. RESULT: In all cases, there were three date stones, two button batteries, one metal gear, one pin, one metal cans pull ring, one glass plate, one arc hard plastic sheet. Seven patients were cured after conservative treatment, and restored normal diet. For the rest 3 cases, patients were cured after the repair operation of tracheoesophageal fistula. CONCLUSION The esophageal perforation must be highly suspected of the esophageal foreign body with a long history, sharp shape or corrosive foreign body. The esophageal radiography may be taken to obtain the final diagnosis. The patients diagnosed as esophageal perforation must be treated with antibiotics, nasal feeding or feeding by gastrostomy, and followed-up closely. Small perforation can heal after a period of time by nasal feeding, while tracheoesophageal fistula was needed to repaire after a period of time for restoring a good physical condition in most cases.
Abscess ; Child ; Esophageal Perforation ; diagnosis ; surgery ; Foreign Bodies ; diagnosis ; surgery ; Humans ; Retrospective Studies ; Tracheoesophageal Fistula ; Tracheotomy

Esophageal perforation after endoscopic forceful pneumatic dilatation for achalasia is a devastating complication and surgical treatment is necessary. A 65-yr-old man and a 54-yr-old woman referred for esophageal perforation two hours after pneumatic dilatation and during the procedure, respectively. Gastroplasties through thoracotomy were performed in both cases and their recoveries were uneventful. The esophagogram with gastrografin on the post-operative 8th day did not show any passage disturbance or leakage at the anastomosis site. On the follow-up endoscopy 4 to 6 months after operation revealed that reflux esophagitis of LA classification A were noted in the both patients. They did not complain any reflux symptom or dysphagia for 9 to 13 months after operation. Instead of the most widely used procedure; primary repair of perforation site, wrapping with intercostal muscle flap and esophagomyotomy, gastroplasty was performed in two cases of iatrogenic esophageal perforation in achalasia and experienced good results.
Aged ; Deglutition Disorders/complications ; Endoscopy, Gastrointestinal/*adverse effects ; Esophageal Achalasia/*surgery ; Esophageal Perforation/*surgery ; Esophagus/*surgery ; Female ; Gastroesophageal Reflux/complications ; Gastroplasty/*methods ; Humans ; Male ; Middle Aged ; Thoracotomy

BACKGROUND/AIMS: Superficial esophageal squamous cell carcinoma (SESCC) is being increasingly detected during screening endoscopy. Endoscopic submucosal dissection (ESD) allows for en bloc and histologically complete resection of lesions. This study assessed the technical feasibility and long-term outcomes of ESD for SESCCs. METHODS: Between January 2005 and August 2012, 27 patients with 28 SESCCs underwent ESD at Pusan National University Hospital. The en bloc and pathologically complete resection rates, complication (perforation and bleeding) rate, incidence of esophageal stricture after ESD, and overall and disease-specific survival rates were evaluated. RESULTS: The en bloc and pathologically complete resection rates were 93% and 83%, respectively. No significant bleeding occurred, and perforation with mediastinal emphysema was observed in two patients (7%). Post-ESD stricture occurred in two patients (7%) who had mucosal defects involving more than three-fourths of the esophageal circumference. During a mean follow-up of 23 months, local tumor recurrence was seen in two of four lesions with pathologically incomplete resection; one was treated by re-ESD, and the other was treated by surgical esophagectomy. The 5-year overall and disease-specific survival rates were 84% and 100%, respectively. CONCLUSIONS: ESD seems to be a feasible, effective curative treatment for SESCCs. All patients should be closely followed after ESD.
Aged ; Carcinoma in Situ/pathology/*surgery ; Carcinoma, Squamous Cell/pathology/*surgery ; Cohort Studies ; Disease-Free Survival ; Dissection ; Esophageal Neoplasms/pathology/*surgery ; Esophageal Perforation ; Esophageal Stenosis ; Esophagoscopy ; Female ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Mucous Membrane/pathology/*surgery ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local/*pathology ; Operative Time ; *Postoperative Complications ; Postoperative Hemorrhage ; Retrospective Studies ; Treatment Outcome ; Tumor Burden

OBJECTIVE: To explore the clinical characteristics and therapies for esophageal perforation complicated with lethal massive hemorrhage caused by esophageal foreign body. METHOD: To retrospective analysis the treatment of massive hemorrhage at the carotid artery or aorta caused by esophageal foreign body in forty seven patients, Foreign body characters, surgical approaches, and postsurgical management were summarized. RESULT: Among 24 patients with cervical esophageal foreign body, the object was removed either by esophagoscopy or through lateral cervical incision. After controlling carotid artery hemorrhage and repairing Fistula of artery from cervical incision, 19 patients survived. For the 23 patients with thoracic esophageal foreign body accompanied with aorta hemorrhea, thoracotomy was performed to remove the foreign body and repair the aortic fistula. Only 3 of these 23 patients recovered from the emergent surgery, other 20 patients died. CONCLUSION For the patients with esophageal foreign body inducing large vessel impingement, the most reliable therapeutic method is surgical repairing of arterial perforation and extraction of the foreign body via cervical or thoracic incision. Carotid ligation should be considered in patients with recurrent carotid hemorrhage. For the patient with mediastinitis, esophageal exclusion is recommended to prevent infection and to promote healing of aortic perforation after aortic fistula repairing.
Adult ; Esophageal Perforation ; etiology ; surgery ; Esophagus ; Female ; Follow-Up Studies ; Foreign Bodies ; complications ; Hemorrhage ; etiology ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVE: To investigate the diagnosis and treatment of esophageal perforation and neck abscess induced by esophageal foreign body and to make a better solution for the disease. METHOD: Twenty-four cases with esophageal perforation and neck abscess induced by esophageal foreign body treated in our department were surgery under general anesthesia. The foreign bodies were removed via esophagoscope in 14 cases, thorocomy in 3 eral neck incision in 5; and no foreign bodies were found in 2 cases. RESULT: There were 16 cases complicated by abscess. Among these complications,there were 10 cases of periesophageal abscess,4 cases of neck abscess and 1 case of mediastinal abscess. In 24 patients, 21 cases cured and one died. One case was sent to the department of endocrinology because of hyperglycaemia and two cases were sent to the department of thoracic surgery for further treatment. CONCLUSION Early diagnosis and treatment is the key to the management of esophageal perforation induced by esophageal foreign body. Thin-section CT has a high value for the diagnosis and differential diagnosis in such patients. Once deep neck abscess is diagnosed, an early abscess surgical drainage, an appropriate antibiotics and a nutrition supporting treatment are effective for the patients.
Abscess ; etiology ; surgery ; Adolescent ; Adult ; Aged ; Diagnosis, Differential ; Drainage ; Esophageal Perforation ; etiology ; surgery ; Esophagus ; Female ; Foreign Bodies ; complications ; surgery ; Humans ; Male ; Middle Aged ; Neck ; pathology ; Young Adult

Endoscopic variceal ligation (EVL) can be performed as an optional therapy for gastric variceal bleeding if endoscopic sclerotherapy (ES) is not readily available or if practitioners lack experience. EVL using an endoscopic pneumo-activated ligating device was performed on a 53-year-old male patient with liver cirrhosis who presented with hematemesis. Follow-up esophagogastroduodenoscopy (EGD) performed two days after the EVL showed gastric perforation at the EVL-procedure site on the gastric fundus. However, the patient refused emergency surgery, and therefore received only supportive management, including intravenous antibiotics. EGD 10 days later showed healing of the perforation site. This is the first report of a case of gastric variceal bleeding with development of a gastric perforation soon after EVL, which showed complete recovery with conservative therapy and without surgical intervention.
Endoscopy, Digestive System ; Esophageal and Gastric Varices/*surgery ; Gastrointestinal Hemorrhage ; Humans ; Intestinal Perforation/etiology ; Ligation/adverse effects ; Liver Cirrhosis/diagnosis ; Male ; Middle Aged ; Tomography, X-Ray Computed