Navigation Links
What should we do when esophageal perforation occurs?

Management of ingested foreign bodies is a common clinical encounter. Complications of this pathology are dependent on a patient's age, the nature and localization of the foreign body, the presence of a perforation, and initial management procedures.

Dr. Christian Righini from the University Medical Center of Grenoble advocates the use of the rigid endoscope which is placed just above the proximal tip of the foreign body where it dilates the esophageal lumen to the extent that the impacted foreign body is movable.

This recommendation is based on Righini's description of a case involving a 52-yr-old man, with no relevant past medical history who presented to the ENT clinic complaining of severe dysphagia, substernal pain, and fever five days after chewing on a piece of chicken. Imaging revealed a fragment of bone in the upper part of esophagus, air in the retropharyngeal space and the upper part of the posterior mediastinum, and deep subcutaneous collection suggestive of cervical posterior mediastinal collection. The patient was managed surgically through both an endoscopic approach and an open cervical approach.

The use of a rigid endoscope during removal of an impacted foreign body has several advantages: it causes expansion of the upper esophagus, which can release totally or in part the impacted foreign body, and prevents aspiration and esophageal or pharyngeal injury. It must be practiced under general anesthesia by a trained operator.

The management of esophageal perforation is dependent on its size and location. Simple suture is recommended in case of small perforation in the cervical esophagus. It is not necessary to use mucosal flaps to reinforce the esophageal sutures, contrarily to the recommendations for injuries of the middle and lower parts of esophagus. In the case of cervical abscess and/or mediastinitis, drainage of the different affected spaces must be carried out.

In conclusion, perforation of the upper esophagus caused by a foreign body is rare, but can cause potentially life threatening mediastinal complications. CT-scanning enables accurate and timely diagnosis and provides valuable indications for treatment. Extraction of the esophageal foreign body with a rigid endoscope is an effective and safe treatment alternative. Non-operative management of esophageal perforation is not an option in the presence of neck and mediastinum abscesses and necessitates a surgical suture and drainage.


Contact: Jing Zhu
World Journal of Gastroenterology

Related medicine news :

1. Mayo Researchers Say ECG Standards Should Be Revised for Elderly
2. Mayo researchers say ECG standards should be revised for elderly
3. First-Time Shoulder Dislocations Helped by Surgery
4. Elbow, Shoulder Injuries Take Heavy Toll on Pro Baseball Players
5. Controversial shoulder surgery for first-time dislocation proven effective long-term
6. Comeback to a Pre-Injury Level After Elbow or Shoulder Surgery Disappointing for Pro Baseball Players
7. Should You Worry About Mercury Poisoning? Find out in the March Issue of Natural Solutions - Now on Newsstands
8. Smith & Nephew Endoscopys BIORAPTOR(TM) 2.3 PK Suture Anchor Provides Secure Repair for Shoulder, Hip Instability
9. That Sex Talk With Your Kids Should Be Ongoing
10. Pain Management For Your Pets, Key Information Every Pet Owner Should Know - Live Webcast to Pet Owners, March 13, 8:00 p.m. to 9:00 p.m. (EDT) Via Morris Animal Foundation
11. Doctors should watch for depression in arthritis patients
Post Your Comments:
(Date:11/30/2015)... ... 30, 2015 , ... The Progressive Dental Institute ... 29 and 30, 2016. The course welcomes dental professionals and members of their ... how to better succeed in the modern dental marketplace. The course combines presentations ...
(Date:11/30/2015)... , ... November 30, 2015 , ... ... key disease-causing component of bacteria could be effective in fighting methicillin-resistant Staphylococcus aureus ... State University. , Their study showed that small molecule analogs that target the ...
(Date:11/30/2015)... NJ (PRWEB) , ... November 30, 2015 , ... Dr. ... With three office locations, patients can visit Dr. Margulies to experience the best available ... to hold the title of "NJ Top Dentist"! , Orthodontics is the branch of ...
(Date:11/30/2015)... ... November 30, 2015 , ... ”Dying Words: The AIDS Reporting ... on December 1, 2015, to coincide with World AIDS Day. The multi-media project will ... covered the AIDS epidemic as he was dying of the disease. , A collaborative ...
(Date:11/30/2015)... ... November 30, 2015 , ... According to RF Safe, the ... scientist at Consumer Reports as supporting a “A Call for Clarity” on cell ... The original Nov 2015 CR story titled, “Does Cell-Phone Radiation Cause Cancer?” ...
Breaking Medicine News(10 mins):
(Date:11/30/2015)... -- Kevin Smith has been appointed Chief Commercial Officer ... wireless monitoring of vital signs.  As CCO based ... Smith will be responsible for the development and ... also directly oversee partnering with US hospitals and ... the first early warning detection device to be ...
(Date:11/30/2015)... Nov. 30, 2015  The fee-for-service reimbursement ... U.S. medical imaging is on its way ... care payer-provider contracts are set to phase ... wake, alter provider-vendor relationships. The shift to ... forward new purchasing frameworks in the medical ...
(Date:11/30/2015)... SAN DIEGO , Nov. 30, 2015 ... ARNA ) today announced that the U.S. Food ... New Drug Application (NDA) for an extended release formulation ... offer patients a chronic weight management treatment in a ... currently approved as an adjunct to a reduced-calorie diet ...
Breaking Medicine Technology: