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Cholesterol crystal embolization following plaque rupture: a systemic disease with unusual features Cholesterol crystal embolic (CCE) syndrome is often a clinically challenging condition that has a poor prognostic implication. It is a result of plaque rupture with release of cholesterol crystals into the circulation that embolize into various tissue organs. Plaque rupture seems to be triggered by an expanding necrotic core during cholesterol crystallization forming sharp tipped crystals (...) including elevated sedimentation rate, abnormal renal function tests and eosinophilia are useful but non-specific. Common target organ involvement includes the skin, kidney, and brain. Various testing including fundoscopic eye examination and other non-invasive procedures such as trans-esophageal echocardiography and magnetic resonance imaging may be helpful in identifying the embolic source. Treatment includes aspirin and clopidogrel, high dose statin and possibly steroids. In rare cases, mechanical
Flood Syndrome: Spontaneous Umbilical Hernia Rupture Leaking Ascitic Fluidâ€”A Case Report We report a rare case of Flood syndrome, which is a spontaneous rupture of an umbilical hernia.A 42-year-old man with decompensated hepatitis C and alcoholic cirrhosis complicated by ascites and esophageal varices presented with 1 day of ascitic fluid drainage after rupture of a preexisting umbilical hernia associated with diffuse abdominal pain and tenderness. A pigtail drain was placed in the right (...) upper abdominal quadrant to decrease fluid drainage from the abdominal wall defect, allowing it to heal naturally.The spontaneous rupture of an umbilical hernia in our patient highlights a rare complication with high mortality rates and stresses the challenge of treatment that falls in the area between medical and surgical management.
); 3 patients were lost to follow-up (9%) and 1 patient died of metastasis after esophagectomy. All other patients were alive with excellent postoperative disease-free survival.Indications for esophagectomy after ESD include ESD failure, cancer recurrence, esophagealrupture, esophageal stricture refractory to endoscopic dilation, and residual tumor at the ESD specimen margin. Stage T1b alone is not an indication for esophagectomy. According to our study, we recommend that esophagectomy should (...) Esophagectomy after endoscopic submucosal dissection for esophageal carcinoma Endoscopic submucosal dissection (ESD) has been used to treat early stage esophageal cancer, but reports about additional esophagectomy after ESD and postoperative outcomes are lacking. Complete removal of cancer tissue together with lymph nodes was the advantage of esophagectomy; however, invasiveness, organ loss, postoperative complications, and worse postoperative quality of life were serious disadvantages
treatment, the dyspnea symptoms disappeared and quality of life significantly improved. Chest computed tomography showed massive necrosis of tumor tissues in each patient. The tumors significantly reduced and a cavity was formed locally in each patient. However, both patients died of massive hemoptysis, probably due to the rupture of the bronchial artery eroded by tumors. The results indicated that apatinib was effective in treating some patients with advanced esophageal cancer, and adverse effects were (...) Fatal hemoptysis in patients with advanced esophageal cancer treated with apatinib Targeted therapy is commonly used for treating advanced malignant tumors. Compared with cytotoxic drugs, targeted drugs have the characteristics of good curative results, less adverse effects, and convenient oral administration. Hence, they are especially suitable for patients with cancer who are not able to tolerate chemotherapy. Anti-angiogenic therapy can achieve the objective by inhibiting the formation
Pemphigus Vulgaris in the Mouth and Esophageal Mucosa Pemphigus vulgaris (PV) is a chronic autoimmune mucocutaneous disease. In most cases, the initial manifestation occurs in the mouth as multiple ulcerations preceded by blisters that rupture and later spread to other mucous membranes and the skin. Esophageal impairment is rare. We report a case of PV with esophageal involvement in a 53-year-old woman who sought medical care, complaining of diffuse painful lesions in the oral cavity (...) for approximately 1 month, with no improvement with nystatin. Upper digestive endoscopy (UDE) was performed with findings of vesiculobullous lesions in the proximal and middle esophagus, which were biopsied and for which histopathology confirmed PV in the esophageal mucosa. We draw attention to UDE as important for the diagnosis, and it should be indicated in patients with vesiculobullous lesions of the mouth, especially if there are esophageal complaints.
Esophageal Perforation After Failed Prehospital Intubation Esophageal perforation is a rare condition with high rates of mortality if not recognized quickly. This is a case of a 67-year-old male with a self-inflicted gunshot wound to the head. He had one failed intubation attempt prior to arrival. On postmortem autopsy it was discovered that in addition to significant head trauma he also had an esophageal and gastric rupture.
Esophageal Perforation and Rupture: a Comprehensive Medicolegal Examination of 59 Jury Verdicts and Settlements. Consequences accompanying esophageal perforation make this complication a prime litigation target. We characterize factors in jury verdicts and settlements regarding esophageal perforation, including operative procedure, patient demographics, alleged cause(s) of malpractice, outcome, and other factors.Pertinent court records were examined for the aforementioned (...) of the factors important in determining legal responsibility is of great interest for practitioners in multiple specialties. The requirement of surgical repair and a delay in diagnosis are two of the most common factors present in litigated cases resulting in a payment. The importance of explicitly listing esophageal perforation in the informed consent for esophagogastroduodenoscopy, abdominal surgery, and any patients at risk of intubation injury needs to be emphasized.
Surgical Management of Esophageal Epiphrenic Diverticula: A Transthoracic Approach Over Four Decades. Epiphrenic esophageal diverticula are infrequent. Although surgical treatment is generally recommended, technique varies widely and optimal management remains controversial. This study evaluated a single-institution experience for surgical treatment of epiphrenic diverticula.A retrospective review was made of medical records of 31 patients undergoing surgical treatment for epiphrenic (...) diverticula from 1974 to 2016.There were 17 men (55%); median age was 65 years. Dysphagia (87%) and regurgitation (71%) were the most common symptoms. Three patients (10%) presented acutely: 2 with ruptured diverticula and 1 with hematemesis. All patients underwent an open transthoracic approach. Diverticulectomy was performed in 28 patients (90%), myotomy in 28 (90%), and a concomitant antireflux procedure in 6 (19%). A total of 22 patients (71%) underwent diverticulectomy and myotomy, 4 (13%) underwent
discordant for esophageal atresia, duodenal atresia with gastric perforation, hypoplastic left heart structures, and significant early gestation maternal polyhydramnios. In this case, fetal magnetic resonance imaging was able to depict additional findings including area of gastric wall rupture, hiatal hernia, dilation of the distal esophagus, and area of duodenal obstruction and thus facilitated the proper diagnosis. After extensive counseling at our multidisciplinary team meeting, the parents elected (...) Twin pregnancy complicated by esophageal atresia, duodenal atresia, gastric perforation, and hypoplastic left heart structures in one twin: a case report and review of the literature The antenatal diagnosis of a combined esophageal atresia without tracheoesophageal fistula and duodenal atresia with or without gastric perforation is a rare occurrence. These diagnoses are difficult and can be suspected on ultrasound by nonspecific findings including a small stomach and polyhydramnios. Fetal
Diaphragmatic Hernia of the Stomach with Gastric Rupture in a Domestic Pig A 5.5-mo-old castrated, male Red Duroc pig presented acutely with depression and abdominal pain 9 d after an altercation with another pig. A CT examination indicated right pneumothorax and herniation of the stomach into the thoracic cavity. Due to a poor prognosis, the pig was euthanized. A necropsy and gross examination revealed a tear of the diaphragmatic muscle in the region of the esophageal hiatus through which (...) the stomach was displaced into the right side of the thoracic cavity. In addition, the herniated stomach had a rupture of the stomach wall through which the gastric mucosa was everted and exposed into the right thoracic cavity. The right thoracic cavity had acute fibrinous pleuritis, and the right lung was collapsed. CT scans performed every 1 to 2 wk for 2 mo prior to the pig's death did not reveal any abnormalities in the diaphragm. Trauma was considered the most likely cause of the diaphragmatic tear
Emergency endoscopic variceal ligation following variceal rupture in patients with advanced hepatocellular carcinoma and portal vein tumor thrombosis: a retrospective study The outcomes of treatment of ruptured varices in patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) are unclear. We therefore evaluated the long- (rebleeding and death) and short-term (immediate death within 24 h of variceal bleeding diagnosis) outcomes of patients with PVTT who underwent (...) emergency variceal band ligation.Data on 62 patients with PVTT and endoscopically proven esophageal or gastric variceal bleeding from 2007 to 2012 were studied. In most cases, the varices were treated using endoscopic variceal band ligation (EVL). We assessed the patients' rebleeding-free and overall survival using the Kaplan-Meier method, and a Cox proportional hazard model was used to analyze effect of independent factors on rebleeding-free and overall survival times.Most patients had decompensated
Subcutaneous cervical emphysema and pneumomediastinum due to a diastatic rupture of the cecum Pneumomediastinum usually occurs after esophageal or chest trauma. Subcutaneous cervical emphysema as a presentation of non-traumatic colonic perforation following colorectal cancer or diverticulitis, is very rare. We report a case of a patient with rectal cancer who developed a diastatic cecum retroperitoneal perforation with a secondary pneumomediastinum and cervical emphysema. The patient
Intragastric Rupture of a Splenic Artery Aneurysm Associated with a Pancreatic Cancer Acute upper digestive tract hemorrhage most often arises from gastric and esophageal vessels located in the mucosa or the submucosa. Rupture in the upper gastrointestinal tract is a classical but uncommon complication of arterial (mainly the abdominal aorta) aneurysms. Splenic artery aneurysm usually ruptures in the peritoneum, unless it is associated with a disease eroding the gastrointestinal wall. We (...) present and describe the management of the rare occurrence of an intragastric rupture of a splenic aneurysm associated with a pancreatic cancer.
Fully covered self-expandable metal stents (SEMS), partially covered SEMS and self-expandable plastic stents for the treatment of benign esophagealruptures and anastomotic leaks. Benign esophagealruptures and anastomotic leaks are life-threatening conditions that are often treated surgically. Recently, placement of partially and fully covered metal or plastic stents has emerged as a minimally invasive treatment option. We aimed to determine the clinical effectiveness of covered stent (...) placement for the treatment of esophagealruptures and anastomotic leaks with special emphasis on different stent designs.Consecutive patients who underwent placement of a fully covered self-expandable metal stent (FSEMS), a partially covered SEMS (PSEMS) or a self-expanding plastic stent (SEPS) for a benign esophagealrupture or anastomotic leak after upper gastrointestinal surgery in the period 2007-2010 were included. Data on patient demographics, type of lesion, stent placement and removal, clinical
Esophagealrupture diagnosed with bedside ultrasound. A 69-year-old man presented to the emergency department with hematemesis, hypotension, tachycardia, and hypothermia. The emergency physician performed a bedside ultrasound of the chest, heart, and abdomen. The heart was unable to be visualized in the parasternal, apical, or subxiphoid windows, and free fluid and particulate matter were visualized in the chest and abdomen. The inability to visualize the heart in the normal cardiac windows (...) suggested a diagnosis of pneumopericardium. Based upon the patient's presenting symptoms and ultrasound findings, an esophageal perforation was suspected. Esophageal perforation is a medical emergency. Deterioration and death due to sepsis can occur within hours of presentation . Although there is a great deal of literature discussing the diagnosis of esophageal perforation by chest radiograph, computed tomography (CT), and esophagography, there are no articles on the role of ultrasound. Esophageal
Guidelines for the Surgical Treatment of Esophageal Achalasia Guidelines for the Surgical Treatment of Esophageal Achalasia - A SAGES Publication Society of American Gastrointestinal and Endoscopic Surgeons Guidelines for the Surgical Treatment of Esophageal Achalasia This document was reviewed and approved by the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in May 2011. Dimitrios Stefanidis, MD, PhD, FACS, FASMBS, William Richardson, MD (...) , Pittsfield, MA, USA Corresponding Author: Dimitrios Stefanidis, MD, PhD, FACS, FASMBS Associate Professor of Surgery Vice Chair of Education Director of MIS/Bariatric Surgery IU Deparment of Surgery Skills Lab Director 545 Barnhill Dr Emerson Hall Indianapolis, IN 46202 Tel: (317) 688-5038 Preamble The guidelines for the surgical treatment of esophageal achalasia are a series of systematically developed statements to assist surgeon (and patient) decisions about the appropriate use of minimally invasive
Management of subtotal tracheal section with esophageal perforation: a catastrophic complication of tracheostomy Herein, we reported a catastrophic condition as the almost complete rupture of trachea associated with esophageal lesion following an urgent surgical tracheostomy performed for unexpected difficult intubation. The extent of lesions required a surgical management. We decided against a resection and an end to end anastomosis but preferred to perform a direct suture of the lesion due
A novel biodegradable esophageal stent: results from mechanical and animal experiments Biodegradable esophageal stents eliminate stent retrieval, but usually induce hyperplasia. This study investigated the properties of a novel biodegradable stent in vitro and in vivo. The degradation of the novel stent was observed in phosphate buffered saline (PBS) for 8 weeks. The radial forces, pH values, morphology, and retention rate of the intrinsic viscosity (R[η]) of the new biodegradable stent were (...) all evaluated. In vitro, the pH values remained constant for 4 weeks and declined from weeks 4 to 8. The biodegradable threads degraded and ruptured at 6 weeks. Consequently, the radial force of the stent decreased to zero at that time. The curve of R[η] decreased with time linearly in PBS. To study the stents in vivo, we used a stricture model in which the middle esophagus of rabbits was damaged by alkali burn. Stents were inserted 2 weeks after injury and observed for 8 weeks. We assessed