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

This is a case report of oesophageal perforation as the complication of a commonly encountered benign disease -- gastroenteritis. A 68-year-old man first presented to the Emergency Department complaining of watery diarrhoea. He was treated and discharged. He re-attended 5 h later complaining of epigastric pain radiating to his back, vomiting bloodstained fluid and persistent watery diarrhoea. Again, he was treated and discharged. He re-attended 3 days later complaining of anorexia, cough, dyspnoea and right-sided chest pain radiating to his back, and subjective weight loss in the previous few days. Chest X-ray revealed right pleural effusion, pneumomediastinum and subcutaneous emphysema in the supraclavicular fossae. Computed chest tomogram and water-soluble contrast swallow confirmed 'spontaneous' oesophageal perforation. Although rare, this entity must be considered in any acutely ill patient complaining of respiratory and gastrointestinal symptoms, especially after recent vomiting.
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PMID:Spontaneous oesophageal perforation as a complication of vomiting in gastroenteritis -- case report. 1524 14

Boerhaave's syndrome represents the most severe perforation of the gastrointestinal tract. The typical clinical presentation is by a sudden onset of pain after a vomiting effort on the background of an alimentary and alcoholic abuse. It usually associates the cervicomediastinal emphysema, altogether forming the Mackler triad. The atypical presentation and the rarity of this entity usually lead to the delay in diagnosis in 50% of the cases. The diagnosis requires native and hydrosoluble contrast radiological examination which may reveal, altogether with the esomedistinal or esopleural fistula, pneumomediastinum, cervical subcutaneous emphysema, pleural effusion or hydropneumothorax. The early diagnosis and surgical treatment in the first 24 hours after the perforation offer the best chances for survival. We present and analyze the cases of 3 patients with spontaneous esophageal rupture with their different evolution and the diagnostic and treatment steps in each case.
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PMID:[Spontaneous esophageal rupture in three patients]. 1581 Jul 7

A 21-year-old female with chronic membranoproliferative nephritis was admitted for suspected esophageal disruption and asthma after severe, prolonged vomiting. At the time of admission she presented with dyspnea, tachypnea, arterial hypotension and tachycardia. Physical examination showed discrete signs of ectopic air at the neck and distended cervical veins. CT-scan of the chest showed severe mediastinal emphysema with compression of the right atrium. After cervical mediastinotomy the cardiorespiratory parameters normalized immediately. Esophagoscopy showed multiple longitudinal mucosal tears between 25 and 45 cm; fluoroscopically, there was no leakage of contrast medium. Following conservative treatment the patient recovered completely and was discharged on day 8.
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PMID:Tension pneumomediastinum after severe vomiting in a 21-year-old female. 1604 64

Spontaneous pneumomediastinum commonly occurs in healthy young men or parturient women in whom an increased intra-alveolar pressure (Valsalva maneuver, asthma, cough, emesis) leads to the rupture of the marginal pulmonary alveoli. The air ascends along the bronchi to the mediastinum and the subcutaneous space of the neck, causing cervico-fascial subcutaneous emphysema in 70-90% of cases. Ninety-five forensic cases, including five cases of hanging, were examined using postmortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) prior to autopsy until December 2003. This paper describes the findings of pneumomediastinum and cervical emphysema in three of five cases of hanging. The mechanism of its formation is discussed based on these results and a review of the literature. In conclusion, when putrefaction gas can be excluded the findings of pneumomediastinum and cervical soft tissue emphysema serve as evidence of vitality of a hanged person. Postmortem cross-sectional imaging is considered a useful visualization tool for emphysema, with a great potential for examination and documentation.
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PMID:Pneumomediastinum and soft tissue emphysema of the neck in postmortem CT and MRI; a new vital sign in hanging? 1613 8

Tonsillectomy is one of the surgical procedures most frequently performed by the ENT specialist. It is considered easy and safe, but many complications have been described. Cervical subcutaneous emphysema and pneumomediastinum are immediate complications relatively infrequent. Deep dissection of the superior pharyngeal constrictor muscle creates a continuity that dries the cervicofacial planes, until it reaches the parapharyngeal, retropharyngeal and prevertebral spaces. It can even reach the mediastinum producing a pneumothorax, which is facilitated by coughing, vomiting or manual ventilation after extubating.
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PMID:[Cervical emphysema after tonsillectomy. A case report]. 1676 5

Boerhaave's syndrome or spontaneous rupture of the esophagus is a rupture of the esophagus after vomiting. It is rare in children, and to date, 26 children have been reported. We present the case of a 5-year-old boy who presented with dyspnea after vomiting and subcutaneous emphysema. The diagnosis was confirmed with esophagoscopy. The patient was successfully treated with a repair of the rupture and a fundoplication. We review the literature on Boerhaave's syndrome in children.
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PMID:Boerhaave's syndrome in children: a case report and review of the literature. 1695 5

Spontaneous pneumomediastinum is a presence of free air in the mediastinum without previous injury and without previously known lung disease. Spontaneous pneumomediastinum is infrequent and little known by physicians. Authors present a case report of three young men with spontaneous pneumomediastinum. There was no evident causation in two cases. In one case there was previous excessive sport activity. Main presenting symptoms were chest and neck pain, odynophagia, dysphonia, vomiting, and neck subcutaneous emphysema. Esophageal perforation was ruled out. All patients recovered spontaneously. Spontaneous pneumomediastinum is the benign disease. Its main importace is in differential diagnosis concerning especially esophageal perforation.
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PMID:[Spontaneous pneumomediastinum]. 1697 63

Spontaneous pneumomediastinum is an uncommon benign disorder that usually occurs in young men. Because of its clinical features and physiopathologic mechanism, other, more serious disorders that could require urgent treatment, such as Boerhaave's syndrome or spontaneous esophageal rupture, must be ruled out. We report the case of a 19-year-old man with no relevant history, who presented mediastinal emphysema after an episode of repeated vomiting in the context of alcohol abuse. Imaging techniques help to assess esophageal involvement.
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PMID:[Spontaneous pneumomediastinum mimicking Boerhaave's syndrome]. 1719 9

Mediastinal and subcutaneous emphysema may occur after dental and oral surgery as a result of iatrogenic introduction of air or injury to the tracheobronchial tree. We report a patient who developed emphysema and pneumothorax after dentoalveolar surgery, which made diagnosis and management difficult. We suggest that persistent postoperative vomiting caused inhalation of mediastinal and intrathoracic air.
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PMID:Pneumomediastinum, bilateral pneumothorax, pleural effusion, and surgical emphysema after routine apicectomy caused by vomiting. 1725 17

Post-emetic spontaneous rupture of the esophagus (Boerhaave's syndrome) is still a life-threatening condition, despite recent advances in thoracic surgery and critical care medicine. Because a case report on anesthetic management of this condition is rare, we report here successful management of a 46-yr-old man with spontaneous esophageal rupture following forceful vomiting. He suddenly developed severe back pain and acute respiratory distress after vomiting during dinner and was brought to our emergency department. Examination on admission revealed an increased respiratory rate of 20 min(-1) with SpO2 97% with a facemask (O2, 3 l x min(-1)), a pulse rate of 100 min(-1), and a blood pressure of 138/88 mmHg. Upper gastrointestinal endoscopy showed a foreign body and CT examination revealed subcutaneous emphysema. He was diagnosed as spontaneous rupture of the esophagus. Emergency T-tube drainage was therefore scheduled. After semi-awake intubation with midazolam, general anesthesia was maintained with O2 (50%), N2O, sevoflurane (2%), and vecuronium infusion. A bronchial blocker was used for one lung ventilation to facilitate thoraco-abdominal approach. A careful attention should be paid to tracheal intubation to avoid any increase in intra-abdominal pressure to prevent further spillage of gastric contents into the mediastinum through the perforation. A transmural tear in the anterior wall of the esophagus was found and the foreign body (boiled meat) was removed. The patient recovered uneventfully and could be extubated on the first day in the ICU. It should be noted that successful management of this disease depends on accurate diagnosis and appropriate choice of treatments.
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PMID:[Anesthetic management of a patient with post-emetic rupture of the esophagus induced by a foreign body]. 1744 50


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