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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Esophageal leak following primary repair of esophageal perforation is a serious complication that can lead to severe mediastinitis and sepsis. Complete diversion with esophageal exclusion or resection is designed to minimize further mediastinal contamination. However, this approach is not necessarily associated with less morbidity or mortality. Furthermore, a second stage operation is required to restore esophageal continuity. From 1986 to 1994, we performed a one-stage primary repair of the distal esophagus in seven patients with either iatrogenic (n = 5) or spontaneous (n = 2) perforations and reinforced the repair by a fundic wrap. One patient underwent an additional modified Heller myotomy for achalasia. Delay between perforation and operation was less than 6 hours in 3 patients, 6 to 24 hours in 2 patients, and greater than 24 hours in 2 patients. Only one patient (14%) developed a small esophageal leak that spontaneously resolved with adequate mediastinal drainage, intravenous antibiotics, and aggressive nutritional support. One patient (14%), whose repair was delayed by 12 hours, died postoperatively of profound sepsis. This patient was moribund from sepsis preoperatively, and postmortem examination of the esophagus revealed no evidence of esophageal leak. Esophageal continuity was maintained in all patients. The median length of stay was 21 days (range, 15-58 days). We conclude that primary reinforced repair of esophageal perforation using a fundic wrap is an effective method of treatment for distal esophageal perforation, even when the repair is delayed by more than 24 hours.
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PMID:One-stage primary repair of distal esophageal perforation using fundic wrap. 766 69

30 patients (less than 15 years old) were admitted for esophageal strictures, 16 of them secondary to corrosive injury. All the patients were treated with endoscopic dilation with Savary Gilliard bougie. The dilatation were done with general anesthesia using an Olympus GIF-XP10 endoscope and with fluoroscopic control. In the esophageal stenosis secondary to caustic ingestion endoscopic injection with Betamethasone was also used. The most frequent site of the stenosis was the upper third of the esophagus, and the main type of stenosis was tubular in the secondary to caustic burns and annular in the other group. In the posteaustic group 385 dilatations were performed in 115 sessions. Two perforations and one sepsis were reported in patients with corrosive stenosis. There was no mortality. 43.7% of the patients with corrosive stenosis and 85.7% with stenosis secondary to other causes obtained complete healing. Oesophageal dilatation with Savary-Gilliary bougies represents a safe and reliable method for the treatment of esophageal strictures.
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PMID:[Treatment of esophageal stenosis with Savary-Gilliard balloons in children]. 856 68

Esophageal fistula may involve the respiratory or cardiovascular system. Fistulas involving the respiratory system which originate from esophageal cancers are the most common. Diagnosis is best made with barium esophagogram. ERF of any cause usually leads to repetitive contamination of the respiratory tract, resulting in sepsis and death of the patient if untreated. In the case of MERF, whether from esophageal or lung cancer, only palliative treatment is usually possible. Better results, including cure, may be expected when a MERF is caused by lymphoma. Curative operation with closure of the fistula is usually possible for BERF if the fistula is identified and treated before irreversible damage has been done by infection, sepsis, and malnutrition. Esophagocardiovascular fistulas occur infrequently in comparison with ERF. These may involve the aorta, usually as a result of a thoracic aneurysm. Rarely one may encounter esophageal fistula to the pericardium or heart. Few survivors have been reported, but successful management is possible if early diagnosis is made and prompt surgical management is undertaken.
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PMID:Surgical management and treatment of esophageal fistula. 884 67

Oesophageal perforations are associated with a high mortality and morbidity. Intrathoracic perforations especially are associated with mediastinitis and sepsis. The repair of these perforations may be difficult, particularly when there has been a delay to diagnosis. We report our use of a method to repair or buttress the suture line after repair with a vascularized intercostal muscle flap, having used it successfully in two patients with intrathoracic oesophageal perforations.
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PMID:Intercostal pedicle flap for thoracic oesophageal perforations. 906 57

Several case reports attest to the pathogenicity of Pasteurella multocida in raptors; however, the pathologic syndromes have not been fully described. We describe here the lesions encountered in 22 avian cholera cases in raptors. Besides septicemia-related lesions, a unique syndrome of esophageal abscesses was noted in 8 of the 11 (73%) Buteo hawks that succumbed to avian cholera. Esophageal abscesses were not noted in birds belonging to the order Strigiformes (owls) or family Falconidae (falcons and their relatives). Thus, the presence of white plaques in both the oropharynx and esophagus of Buteo hawks may indicate a possible P. multocida infection and should be considered in the differential diagnosis. This study also documents the first cases of avian cholera in a rough-legged hawk (Buteo lagopus) and a flammulated owl (Otus flammeolus).
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PMID:Lesions associated with Pasteurella multocida infection in raptors. 908 38

Tracheoesophageal fistula is a complication of endotracheal canulas with pressure balloon during mechanical ventilation, for which treatment is surgical closure. There are approximately 80 reported cases in the world literature. Here we report our experience at the National Institute of Respiratory Diseases of Mexico. We performed surgical treatment of 7 patients (4 males, 3 females, 17 to 65 years of age) with tracheoesophageal fistula from 1991 to 1995, referred from other hospitals. Six had a history of prolonged orotracheal intubation, and the seventh had a traumatic lesion of the neck. Preoperatory management varied from 1 to 8 weeks, with treatment of malnutrition and infections. Esophagus was sutured with polyglactin 000 in two layers, the inner with interrupted, and the superficial with continuous sutures. The area was covered with a muscle strap. In six patients, simple suture of trachea was performed. In the seventh, due to an extensive tracheal defect, we decided to use a second muscle strap to occlude it. Six patients have had a follow up of 15 months to 5 years with satisfactory evolution. One patient died due to abdominal sepsis. We conclude that this technique provides a good prognosis for this disorder.
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PMID:[Surgical treatment of non-malignant tracheoesophageal fistula]. 978 84

Anastomotic failure remains to be one of the main problems in esophageal surgery with leakage rates up to 30% being reported currently. We addressed that problem by modifying the gastric-tube formation in utilizing all of the gastric fundus and omitting the resection of the lesser gastric curvature and accompanying vessels. Experimentally, those fundus-rotation gastroplasties were significantly longer and better perfused than conventional gastroplasties. In a clinical series of 53 patients (45 male, eight female, range 42-83 years) undergoing esophageal resection (49 malignancies, four non-malignant esophageal disease), four anastomotic leakages were found (7.5%). Three patients died due to a bronchial leak and adult respiratory distress syndrome, one with a complete gastric-tube necrosis and one with a colon perforation, sepsis and multiorgan failure. Eight patients developed a significant anastomotic stricture requiring repeated endoscopic dilatations. From our experimental and clinical experience, we conclude that the favorable length and perfusion of fundus-rotation gastroplasties allow for safe anastomosis at either the cervical or thoracic level.
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PMID:Fundus rotation gastroplasty: a modified gastric tube. 1069 48

Esophageal variceal hemorrhage is frequently a catastrophic event. The specific events that trigger variceal rupture are not well understood. Acute elevations in systemic blood pressure and increased splanchnic blood flow, however, may lead to increased intravariceal pressure followed by variceal rupture and hemorrhage. This report describes a strong temporal association between complicated endotracheal intubation and abrupt onset of life-threatening variceal hemorrhage. A 52-year-old man with a history of portal hypertension was intubated emergently for airway protection because of respiratory insufficiency due to sepsis. Intubation was complicated by initial inadvertent esophageal intubation and by a peak mean arterial blood pressure of 155 mmHg. At the conclusion of the procedure, the patient sustained large volume hematemesis due to esophageal variceal rupture. This case suggests a risk of triggering variceal hemorrhage as a result of intubation-induced increase in blood pressure. A number of agents, including fentanyl, have been shown to be effective in attenuating the cardiovascular response to intubation. This case report provides strong evidence in support of administering fentanyl, or a suitable alternative adjunctive medication, before intubation of patients with documented portal hypertension and a history of esophageal variceal hemorrhage.
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PMID:Massive esophageal variceal hemorrhage triggered by complicated endotracheal intubation. 1072 69

The objective of this study was to evaluate the therapeutic usefulness of chemoradiotherapy (CRT) followed by surgery in patients with clinically T4 (cT4) esophageal cancer involving adjacent organs such as the trachea, main bronchi, and large vessels. Thirty-seven patients with cT4 squamous cell carcinoma of the thoracic esophagus were enrolled in this study. The CRT regimen comprised cisplatin (70 mg/m2) on day 1, 5-fluorouracil (700 mg/m2) on days 1-4 and external irradiation (200 cGy/day, total 30 Gy) on either days 8-26 (sequential schedule, n=15) or days 1-19 (concurrent schedule, n022). Two courses of CRT were given. The results of CRT were complete response in nine patients, partial response in 19, no change in three (minor response in two), and progressive disease in six patients. The median response duration in all responders was 172 days (range: 56-2469, n=19). After CRT, 13 patients received surgery. In 12 of these patients, tumors were completely resected. Histopathologic examination of the resected specimen revealed a discrepancy between clinical response and histopathologic effect. The median duration of survival and the 1-, 2- and 5-year survival rates were 304 days (84-3155), 45%, 35% and 23% in all patients, respectively, 866 days (190-3155), 83%, 83% and 57% in the 13 patients whose tumors were resected, and 187 days (84--2630), 25%, 5% and 5% in the 24 patients whose tumors were not resected. Grade 3 toxicity, especially hematological reactions, was noted in 13.5% (5/37) of the patients. There was one toxicity-related death (sepsis). A good outcome may be obtained with CRT, followed by surgery when feasible. However, CRT can cause toxic reactions, and close monitoring of patients is required.
Dis Esophagus 2001
PMID:Chemoradiotherapy followed by surgery for thoracic esophageal cancer potentially or actually involving adjacent organs. 1186 19

Prompt diagnosis and effective treatment are important for thoracic esophageal perforations. The decision for proper management is difficult especially when diagnosed late. However, there is an increasing consensus that primary repair provides good results for repair of thoracic esophageal perforations, which are not diagnosed on time. Primary repair for thoracic esophageal perforations was applied in 20 out of 25 consecutive patients. The time interval between perforation and repair was less than 24 h in six patients (group I), and more than 24 h in 14 patients (group II). The remaining five patients underwent esophagectomy with simultaneous or staged reconstruction because of incorrectable underlying esophageal pathology. Group I had much more iatrogenic causes (P < 0.05). Preoperative sepsis occurred only in group II (P=0.05) and was highly associated with Boerhaave syndrome (P=0.001). Regional viable tissue was used to reinforce the sites of primary repair (n=15, 75%). All of the postoperative morbidity (n=9, 45%) including esophageal leaks (n=6, 30%) and operative death (n=1, 5%) occurred in group II. In patients with postoperative leaks, five eventually healed, but one became a fistula that required reoperation. Primary healing with preservation of the native esophagus was achieved in all 19 patients except one operative death. In addition, the increased incidence of leak and morbidity did not lead to an increase in mortality. In the esophagectomy group, there was no mortality, but one minor suture leak. Regardless of the time interval between the injury and the operation, primary repair is recommended for non-malignant, thoracic, esophageal perforations, but not for anastomotic leaks. Reinforcement that may change the nature of a possible leak is also useful. For incorrectable underlying esophageal pathology, esophagectomy with simultaneous or staged reconstruction is indicated.
Dis Esophagus 2002
PMID:Surgery in thoracic esophageal perforation: primary repair is feasible. 1244 91


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