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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Spontaneous perforation of the oesophagus is extremely rare in children, as is perforation due to vomiting in pregnancy. We report the case of a 15-year-old in whom vomiting in early pregnancy resulted in oesophageal perforation with subcutaneous emphysema causing marked facial swelling in the absence of other signs. The more common clinical presentation of spontaneous oesophageal rupture (Boerhaave's syndrome) is discussed.
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PMID:Vomiting in pregnancy resulting in oesophageal perforation in a 15-year-old. 828 84

The case of a 16-year old female is presented who underwent laparoscopy under general anaesthesia and uncomplicated endotracheal intubation. Four hours after uneventful anaesthesia and extubation the patient started vomiting and coughing. Subcutaneous tissue emphysema developed and pneumomediastinum was diagnosed on a chest roentgenogram. A small lesion in the posterior wall of the trachea and consequent upon intubation by indirect tracheoscopy was identified as the possible source of air entry on the third postoperative day. Air accumulation and tracheal lesion protractedly responded to antitussive and antibiotic medication. A tracheal lesion during intubation is the most frequent and thus the most probable cause of air accumulation presenting as pneumomediastinum, pneumothorax or subcutaneous emphysema. As in the present case, increased airway pressure from vomiting or coughing even after a latent period may induce the phenomenon. Very occasional reports on spontaneous pneumomediastinum in young individuals must not detract the circumstances of endotracheal intubation from suspecting an iatrogenic lesion, confirming it by immediate endoscopy and thereupon deciding on conservative or surgical treatment.
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PMID:[Postoperative mediastinal and subcutaneous emphysema after intubation narcosis]. 876 47

We present the first reported case of vision loss due to tension orbital emphysema associated with tension pneumocephalus resulting from blunt trauma. In the setting of trauma, intraorbital air indicates paranasal sinus-orbital communication. Tension orbital emphysema may cause vision loss through optic nerve compression, ischemia, or contusion; or central retinal artery occlusion. Vision impairment after craniofacial injury should prompt urgent computed tomography. Tension orbital emphysema with associated vision impairment requires treatment including direct decompression and, in some cases, high-dose steroids to preserve vision. Increases in sinus pressure from coughing, nose-blowing, or vomiting should be avoided until definitive treatment can be instituted.
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PMID:Tension pneumocephalus and tension orbital emphysema following blunt trauma. 883 34

The first case of spontaneous mediastinal emphysema was reported by Hamman et al. in 1939. It is a rare condition that primarily occurs in young adults. In many instances, spontaneous mediastinal emphysema is caused by yelling, shouting or active exercise, but the cause is often unknown. It is rare for cases of spontaneous mediastinal emphysema to recur. Recently, we experienced a recurrent case of spontaneous mediastinal emphysema in a patient with a duodenal ulcer. Vomiting appeared to be the cause of the recurrence in our patient. Of the 58 patients with spontaneous mediastinal emphysema who have been reported in Japan so far, recurrences were documented only in our patient and two others.
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PMID:A recurrent case of spontaneous mediastinal emphysema. 886 48

Mediastinitis caused by infection with Clostridium perfringens and spontaneous rupture of the esophagus are both life threatening conditions. The combination of these two entities led to septic multiorgan failure in a 38-year-old woman. The patient was treated successfully by esophagectomy and postoperative lavage through a partially open abdomen. The lack of information regarding emesis, the leading symptom of Boerhaave's syndrome, caused delayed diagnosis: the triad of emesis, severe epigastric pain and emphysema of the skin was not established until 30 h after the onset of symptoms.
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PMID:[Gas gangrene mediastinitis after Boerhaave syndrome]. 941 Jun 84

Spontaneous esophageal perforation, or Boerhaave syndrome, is an uncommon finding requiring prompt diagnosis and immediate surgery because of its high mortality rate. The clinical diagnosis in typical cases is based on the symptom triad of Macler: vomiting, strong sudden chest pain and subcutaneous emphysema. We report 4 cases of Boerhaave syndrome with atypical presentation studied with Computed Tomography (CT) to make the correct diagnosis with atypical clinical findings. In each patient, we assessed the clinical symptoms, classifying them as typical and atypical, the diagnostic course leading to diagnosis and CT patterns. The classic symptoms were absent in one patient, while one patient had vomiting only, one had vomiting and chest pain and one had chest pain and cough. Chest radiography was performed in three patients and permitted the diagnosis in one of them only. CT permitted the definitive diagnosis in all cases. When spontaneous esophageal rupture presents with aspecific clinical findings. CT permits its accurate and specific diagnosis. We found atypical CT signs of esophageal rupture, namely pneumopericardium, uncommunicating mediastinal and pleural effusions, and focal pleural effusion in a contralateral cavity. Finally, our finding of a periesophageal mediastinal collection moving to the parietal subpleural space is not reported in the radiological literature. The severity of these findings varies and it is probably related to the increase in intraesophageal pressure affecting the progression of abscessual and hydroaerial collections in different anatomical structures; the time when CT is performed is also important. To conclude, the CT diagnosis of spontaneous esophageal rupture is specific and CT shows lesion site correctly.
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PMID:[Spontaneous rupture of the esophagus (Boerhaave syndrome): computerized tomography diagnosis in atypical clinical presentation]. 942 52

Laparoscopy employs highly technical equipment, and the surgeon needs special training in the technique. He should master in-depth knowledge of the use of optics, electrical principles, gas under pressure, and the physiologic changes that occur when carbon dioxide is placed in the abdominal cavity. Above all, the surgeon must adhere rigidly to guidelines for appropriate technique, and deviation will most assuredly result in complications and even death. General surgery application of laparoscopy followed a wealth of medical experience from gynecological laparoscopies, which declared the technique as safe, reduced hospital stay with little pain and disfigurement. Laparoscopic cholecystectomy started to enjoy ever increasing popularity. It retained the advantages of shorter hospital stay, more rapid return to normal activities, less pain, small incisions and less postoperative ileus compared with the traditional open cholecystectomy. Soon many procedures were done using this new technique in adults and children. Anesthesia for laparoscopy has been established with a broad usage of agents and techniques. General anesthesia using balanced anesthesia technique including intravenous induction agents like: thiopentone, propofol, etomidate, and inhalational agents like nitrous oxide, isoflurane, desflurane, has been reported. Variety of muscle relaxants including succinylcholine, mivacurium, atracurium, vecuronium aiming at rapid recovery and cardiovascular stability. Total intravenous anesthesia using agnets like propofol, midazolam and ketamine, alfentanil and vecuronium has been reported also for outpatient laparoscopy. Epidural anesthesia was considered as safe alternative to general anesthesia for outpatient laparoscopy without associated respiratory depression. As for pain relief, many methods have been used. The pain mechanism is variable and analgesia requirement is less than those of open surgery. Cited complications include pneumothorax, cardiovascular collapse, surgical emphysema and pneumo-peritoneum complications. Among the implication for anesthesia care, the importance of preoperative monitoring, careful positioning and observation during the insufflation of carbon dioxide. The drive to have short term admission to hospital would make it imperative to use short acting rapidly eliminated anesthetic drugs, avoidance of vomiting and pain by proper use of modern anti-emetics and NSAID to help in avoidance of narcotics or reduction of the requirement.
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PMID:Anesthesia for laparoscopic general surgery. A special review. 1006 70

Minimally invasive therapy aims to minimize the trauma of any interventional process but still achieve a satisfactory therapeutic result. The development of "critical pathways," rapid mobilization and early feeding have contributed towards the goal of shorter hospital stay. This concept has been extended to include laparoscopic cholecystectomy and hernia repair. Reports have been published confirming the safety of same day discharge for the majority of patients. However, we would caution against overenthusiastic ambulatory laparoscopic cholecystectomy on the rational but unproven assumption that early discharge will lead to occasional delays in diagnosis and management of postoperative complications. Intraoperative complications of laparoscopic surgery are mostly due to traumatic injuries sustained during blind trocar insertion and physiologic changes associated with patient positioning and pneumoperitoneum creation. General anesthesia and controlled ventilation comprise the accepted anesthetic technique to reduce the increase in PaCO2. Investigators have recently documented the cardiorespiratory compromise associated with upper abdominal laparoscopic surgery, and particular emphasis is placed on careful perioperative monitoring of ASA III-IV patients during insufflation. Setting limits on the inflationary pressure is advised in these patients. Anesthesiologists must maintain a high index of suspicion for complications such as gas embolism, extraperitoneal insufflation and surgical emphysema, pneumothorax and pneumomediastinum. Postoperative nausea and vomiting are among the most common and distressing symptoms after laparoscopic surgery. A highly potent and selective 5-HT3 receptor antagonist, ondansetron, has proven to be an effective oral and IV prophylaxis against postoperative emesis in preliminary studies. Opioids remain an important component of the anesthesia technique, although the introduction of newer potent NSAIDs may diminish their use. A preoperative multimodal analgesic regimen involving skin infiltration with local anesthesia. NSAIDs to attenuate peripheral pain and opioids for central pain may reduce postoperative discomfort and expedite patient recovery/discharge. There is no conclusive evidence to demonstrate clinically significant effects of nitrous oxide on surgical conditions during laparoscopic cholecystectomy or on the incidence of postoperative emesis. Laparoscopic cholecystectomy has proven to be a major advance in the treatment of patients with symptomatic gallbladder disease.
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PMID:Anesthetic implications of laparoscopic surgery. 1060 86

Tears of the oesophageal wall following sudden forceful vomiting are well documented in literature. In Boerhaave's syndrome there is transmural rupture associated with complications including pneumothorax, pneumomediastinum, surgical emphysema and shock. In Mallory-Weiss syndrome mucosal tears are associated with haematemesis and shock. In neither of these conditions has intraluminal obstruction been described as an aetiological factor. We present a case with similar pathophysiology where oesophageal obstruction by a meat bolus followed by forceful vomiting led to an oesophageal mucosal tear and presentation of a band of oesophageal mucosa in the oral cavity. The patient did not develop any complications and made an uneventful recovery following conservative management.
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PMID:Oral presentation of an oesophageal mucosal tear. 1062 6

AIMS: Spontaneous rupture of the oesophagus (SRO) is a rare and often fatal event. The aim of this study was to evaluate the presentation, management and outcome of SRO in a single unit. METHODS: Data were collected on all patients presenting with SRO over a 5-year period with respect to presenting features, diagnostic investigations and subsequent management. Statistical analysis was by Student's t test, chi2 and Fisher's exact tests. RESULTS: Fourteen patients were identified, 12 men and two women with a median age of 64 (range 18-78) years; eight were tertiary referrals. Thirteen of 14 patients presented with chest or upper abdominal pain following vomiting or retching and 13 had an abnormal initial chest radiograph; only one presented with Mackler's triad of pain, vomiting and surgical emphysema. The median delay to diagnosis was 21 (range 1-84) h; this delay did not significantly affect outcome (P = 0.16). An endoscopic assessment and contrast swallow were performed in all patients. Nine of ten patients with a demonstrable leak and full-thickness tear were managed surgically and the four patients with no leak were managed conservatively (P = 0.005); surgical management consisted of thoracotomy, lavage, repair of the perforation and a feeding jejunostomy. Seven patients had a repair over a T tube and two had a primary repair. All conservatively managed patients had contained, controlled or intramural perforations and two also required a feeding jejunostomy. Patients requiring surgery had a longer hospital stay (mean(s.d.) 57.9(34.8) versus 22.2(30.7) days; P = 0.081) and a significantly longer intensive care unit stay (P = 0.044). The overall mortality rate from SRO was 14 per cent (two patients); no deaths occurred in the conservatively managed group. CONCLUSIONS: SRO continues to be diagnosed late despite a classical history and/or abnormal chest radiograph. Endoscopic assessment of perforations is safe and in combination with a contrast swallow can confidently predict patients with contained or controlled rupture in whom non-operative management is successful.
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PMID:Management of spontaneous rupture of the oesophagus 1071 69


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