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Esophageal Rupture

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121. Successful management of esophageal necrosis after endovascular repair of chronic type B aortic dissection. (Abstract)

Successful management of esophageal necrosis after endovascular repair of chronic type B aortic dissection. We report the case of a 65-year-old patient with esophageal necrosis that developed after thoracic endovascular aortic repair (TEVAR) of a previously stented, ruptured chronic type B aortic dissection. The cause of this complication may have been related to an infected mediastinal hematoma causing esophageal compression. Emergent esophagectomy was performed with success. Copyright © 2014

2014 Annals of Thoracic Surgery

122. Esophageal Gastrointestinal Stromal Tumor: Is Tumoral Enucleation a Viable Therapeutic Option? Full Text available with Trip Pro

Esophageal Gastrointestinal Stromal Tumor: Is Tumoral Enucleation a Viable Therapeutic Option? The primary objective was to evaluate the feasibility of surgical enucleation of esophageal gastrointestinal stromal tumors (E-GISTs). Secondary objectives evaluated (i) the impact of tumor enucleation on oncological outcomes, (ii) the effect of pretherapeutic biopsy on the feasibility of E-GIST enucleation, and (iii) the impact of mucosal ulceration on outcome.E-GISTs are very rare tumors (...) and esophageal resection has been the recommended approach. The feasibility and impact on outcomes of tumor enucleation are unknown.Through a large national multicenter retrospective study, 19 patients with E-GISTs were identified between 2001 and 2010. Patients who underwent either enucleation or esophagectomy were compared.Of over 19 patients identified with E-GISTs, curative treatment was surgical for 16 patients, with enucleation in 8 and esophagectomy in 8. In the enucleation group, median tumoral

2014 Annals of Surgery

123. Ruptured celiac artery aneurysm mimicking Boerhaave syndrome. (Abstract)

. Diagnostic left thoracentesis yielded bloody fluid with similar amylase level to serum. The chest computed tomographic scan showed no evidence of esophageal rupture. However, a ruptured celiac artery aneurysm with retroperitoneal hematoma extending to the posterior mediastinum and bilateral pleural space was found incidentally. Although ruptured celiac artery aneurysm is an uncommon cause for postemetic epigastralgia, acute vascular events such as the previously stated cause should be the first (...) Ruptured celiac artery aneurysm mimicking Boerhaave syndrome. Ruptured celiac artery aneurysm is a rare cause for epigastric pain and is usually detected incidentally. Atypical presentation with postemetic epigastralgia and pleural effusion usually leads physicians to make the diagnosis of Boerhaave syndrome. Herein, we report a 32-year-old woman who was diagnosed with Boerhaave syndrome initially after presenting with acute postemetic epigastralgia and predominant left side pleural effusion

2013 American Journal of Emergency Medicine

124. Esophageal Stricture (Overview)

reflux: implications in the development of complications in Barrett''s columnar-lined lower esophagus. Surgery . 1989 Oct. 106(4):764-70. . Bell NJ, Burget D, Howden CW. Appropriate acid suppression for the management of gastro-oesophageal reflux disease. Digestion . 1992. 51 Suppl 1:59-67. . Berenson GA, Wyllie R, Caulfield M. Intralesional steroids in the treatment of refractory esophageal strictures. J Pediatr Gastroenterol Nutr . 1994 Feb. 18(2):250-2. . Botoman VA, Surawicz CM. Bacteremia (...) . 1991 Nov-Dec. 37(6):650-1. . Heller SR, Fellows IW, Ogilvie AL. Non-steroidal anti-inflammatory drugs and benign oesophageal stricture. Br Med J (Clin Res Ed) . 1982 Jul 17. 285(6336):167-8. . Kadakia SC, Parker A, Carrougher JG. Esophageal dilation with polyvinyl bougies, using a marked guidewire without the aid of fluoroscopy: an update. Am J Gastroenterol . 1993 Sep. 88(9):1381-6. . Kuo WH, Kalloo AN. Reflux strictures of the esophagus. Gastrointest Endosc Clin N Am . 1998 Apr. 8(2):273-81

2014 eMedicine.com

125. Esophagitis (Overview)

distinguish eosinophilic esophagitis from gastroesophageal reflux disease. Clin Gastroenterol Hepatol . 2009 Dec. 7(12):1305-13; quiz 1261. . . Howden CW, Hornung CA. A systematic review of the association between Barrett's esophagus and colon neoplasms. Am J Gastroenterol . 1995 Oct. 90(10):1814-9. . Uygun I. Caustic oesophagitis in children: prevalence, the corrosive agents involved, and management from primary care through to surgery. Curr Opin Otolaryngol Head Neck Surg . 2015 Dec. 23 (6):423-32 (...) on the underlying disease. Esophagitis is commonly seen in adults and is uncommon in childhood. Infectious esophagitis. Candida esophagitis. Double-contrast esophagram shows linear plaquelike lesions in the esophagus, with normal intervening mucosa. Signs and symptoms The history and physical examination findings vary according to the type of esophagitis present. Symptoms of reflux esophagitis (the most common type) may include the following: Heartburn, or dyspepsia (the most common symptom) Water brash

2014 eMedicine.com

126. Esophageal Varices (Overview)

seen on endoscopy. Courtesy of Wikimedia Commons. Uphill esophageal varices. Barium swallow demonstrates multiple serpiginous filling defects primarily involving the lower one third of the esophagus with striking prominence around the gastroesophageal junction. The patient had cirrhosis secondary to alcohol abuse. Signs and symptoms Signs and symptoms of liver disease include the following: Weakness, tiredness, and malaise Anorexia, weight loss (common with acute and chronic liver disease) Sudden (...) complication of portal hypertension, (see , , , and ). (See the images below.) Uphill esophageal varices. Barium swallow demonstrates multiple serpiginous filling defects primarily involving the lower one third of the esophagus with striking prominence around the gastroesophageal junction. The patient had cirrhosis secondary to alcohol abuse. Barium swallow demonstrating esophageal varices involving the entire length of the esophagus. This appearance may be seen in advanced uphill varices or downhill

2014 eMedicine.com

127. Esophageal Hematoma (Overview)

. Spontaneous esophageal hematoma. Am J Gastroenterol . 1999 Dec. 94(12):3655. . Chen TA, Lo GH, Lai KH. Spontaneous rupture of iatrogenic intramural hematoma of esophagus during endoscopic sclerotherapy. Gastrointest Endos . 1999 Dec. 50(6):850-1. . Hiller N, Zagal I, Hadas-Halpern I. Spontaneous intramural hematoma of the esophagus. Am J Gastroenterol . 1999 Aug. 94(8):2282-4. . Meulman N, Evans J, Watson A. Spontaneous intramural haematoma of the oesophagus: a report of three cases and review (...) usually subsides within 2 weeks after the primary event. Recurrence is extremely rare. Mortality/Morbidity If the hematoma is associated with a perforation of the esophagus, septic complications (eg, mediastinitis, abscess formation) are likely to occur. The mortality rate associated with esophageal perforations is about 10-20%. [ ] Previous References Freeman AH, Dickinson RJ. Spontaneous intramural oesophageal haematoma. Clin Radiol . 1988 Nov. 39(6):628-34. . Adeonigbagbe O, Khademi A, Washington M

2014 eMedicine.com

128. Esophageal Stricture (Follow-up)

stenosis in a child. Endoscopy . 2009. 41 Suppl 2:E73. . Vollan G, Stangeland L, Soreide JA. Long term results after Nissen fundoplication and Belsey Mark IV operation in patients with reflux oesophagitis and stricture. Eur J Surg . 1992 Jun-Jul. 158(6-7):357-60. . Wilcox CM, Alexander LN, Clark WS. Localization of an obstructing esophageal lesion. Is the patient accurate?. Dig Dis Sci . 1995 Oct. 40(10):2192-6. . Wilkins WE, Ridley MG, Pozniak AL. Benign stricture of the oesophagus: role of non (...) fundoplication), esophageal lengthening with antireflux surgery (Collis-Nissen or Belsey gastroplasty) Esophageal resection and reconstruction - Gastric or colon interposition or jejunal segment If the benign peptic stricture is dilatable, an esophageal-sparing operation is performed. Note the following: If the length of the esophagus is normal, standard antireflux surgery and postoperative dilation as necessary is recommended. If the esophagus is short, performing Collis gastroplasty and postoperative

2014 eMedicine.com

129. Esophageal Webs and Rings (Follow-up)

, cutting solid food into smaller pieces, and eating slowly. Before patients take oral medications, warn patients of the hazard of pills lodging in their esophagus; hence, they should cut large sized pills into smaller pieces prior to ingestion when possible. In addition, instruct patients to drink at least 8 ounces of liquid and to avoid laying supine for at least 30 minutes after taking their oral medications. These precautionary measures may prevent pill-induced esophagitis even in patients without (...) passage of a single Maloney bougie (46-58F), regardless of ring rupture. [ ] However, repeat dilation is safe and effective. Unlike the lower esophageal rings, patients with multiple esophageal rings follow a set of different therapeutic rules for esophageal dilation. This recommendation is based on the author's cumulative experience with this rare condition. The esophageal lumen in patients with multiple esophageal rings is typically much narrower than in patients with lower esophageal rings. Medical

2014 eMedicine.com

130. Esophageal Varices (Follow-up)

thirds of the stomach, with staple gun transection of the lower esophagus) (eg, splenectomy, gastroesophageal devascularization, and esophageal transection [at times]). The incidence of liver failure and encephalopathy is low following devascularization procedures, presumably because of better maintenance of portal flow. However, these procedures are rarely performed but may have a role in patients with portal and splenic vein thrombosis who are not suitable candidates for shunt procedures and who (...) -pump inhibitor for 10 days after EVL can reduce the size of these ulcers. [ ] Previous Next: Treatment Complications Complications related to the therapeutic procedures used in management of bleeding esophageal varices include the following: Balloon tamponade - Aspiration pneumonia, esophageal perforation, superficial lesions of the gastric mucosa, and pressure necrosis of the nasal passages, mouth, or lips Sclerotherapy - Perforation of the esophagus (2-6%), esophageal ulceration and bleeding (2

2014 eMedicine.com

131. Esophageal Hematoma (Follow-up)

of the esophageal wall have been reported during endoscopy of an esophageal hematoma. Previous References Freeman AH, Dickinson RJ. Spontaneous intramural oesophageal haematoma. Clin Radiol . 1988 Nov. 39(6):628-34. . Adeonigbagbe O, Khademi A, Washington M. Spontaneous esophageal hematoma. Am J Gastroenterol . 1999 Dec. 94(12):3655. . Chen TA, Lo GH, Lai KH. Spontaneous rupture of iatrogenic intramural hematoma of esophagus during endoscopic sclerotherapy. Gastrointest Endos . 1999 Dec. 50(6):850-1. . Hiller N (...) secondary to anticoagulation therapy for mitral valve replacement. J Card Surg . 2016 Dec. 31(12):740-741. . Marks IN, Keet AD. Intramural rupture of the oesophagus. Br Med J . 1968 Aug 31. 3(617):536-7. . Yamashita S, Takeno S, Moroga T, et al. Successful treatment of esophageal repair with omentum for the spontaneous rupture of the esophagus (Boerhaave's syndrome). Hepatogastroenterology . 2012 May. 59(115):745-6. . Yin A, Li Y, Jiang Y, Liu J, Luo H. Mallory-Weiss syndrome: clinical and endoscopic

2014 eMedicine.com

132. Esophageal Varices (Diagnosis)

seen on endoscopy. Courtesy of Wikimedia Commons. Uphill esophageal varices. Barium swallow demonstrates multiple serpiginous filling defects primarily involving the lower one third of the esophagus with striking prominence around the gastroesophageal junction. The patient had cirrhosis secondary to alcohol abuse. Signs and symptoms Signs and symptoms of liver disease include the following: Weakness, tiredness, and malaise Anorexia, weight loss (common with acute and chronic liver disease) Sudden (...) complication of portal hypertension, (see , , , and ). (See the images below.) Uphill esophageal varices. Barium swallow demonstrates multiple serpiginous filling defects primarily involving the lower one third of the esophagus with striking prominence around the gastroesophageal junction. The patient had cirrhosis secondary to alcohol abuse. Barium swallow demonstrating esophageal varices involving the entire length of the esophagus. This appearance may be seen in advanced uphill varices or downhill

2014 eMedicine.com

133. Esophagitis (Diagnosis)

distinguish eosinophilic esophagitis from gastroesophageal reflux disease. Clin Gastroenterol Hepatol . 2009 Dec. 7(12):1305-13; quiz 1261. . . Howden CW, Hornung CA. A systematic review of the association between Barrett's esophagus and colon neoplasms. Am J Gastroenterol . 1995 Oct. 90(10):1814-9. . Uygun I. Caustic oesophagitis in children: prevalence, the corrosive agents involved, and management from primary care through to surgery. Curr Opin Otolaryngol Head Neck Surg . 2015 Dec. 23 (6):423-32 (...) on the underlying disease. Esophagitis is commonly seen in adults and is uncommon in childhood. Infectious esophagitis. Candida esophagitis. Double-contrast esophagram shows linear plaquelike lesions in the esophagus, with normal intervening mucosa. Signs and symptoms The history and physical examination findings vary according to the type of esophagitis present. Symptoms of reflux esophagitis (the most common type) may include the following: Heartburn, or dyspepsia (the most common symptom) Water brash

2014 eMedicine.com

134. Esophageal Hematoma (Diagnosis)

. Spontaneous esophageal hematoma. Am J Gastroenterol . 1999 Dec. 94(12):3655. . Chen TA, Lo GH, Lai KH. Spontaneous rupture of iatrogenic intramural hematoma of esophagus during endoscopic sclerotherapy. Gastrointest Endos . 1999 Dec. 50(6):850-1. . Hiller N, Zagal I, Hadas-Halpern I. Spontaneous intramural hematoma of the esophagus. Am J Gastroenterol . 1999 Aug. 94(8):2282-4. . Meulman N, Evans J, Watson A. Spontaneous intramural haematoma of the oesophagus: a report of three cases and review (...) usually subsides within 2 weeks after the primary event. Recurrence is extremely rare. Mortality/Morbidity If the hematoma is associated with a perforation of the esophagus, septic complications (eg, mediastinitis, abscess formation) are likely to occur. The mortality rate associated with esophageal perforations is about 10-20%. [ ] Previous References Freeman AH, Dickinson RJ. Spontaneous intramural oesophageal haematoma. Clin Radiol . 1988 Nov. 39(6):628-34. . Adeonigbagbe O, Khademi A, Washington M

2014 eMedicine.com

135. Esophageal Stricture (Diagnosis)

reflux: implications in the development of complications in Barrett''s columnar-lined lower esophagus. Surgery . 1989 Oct. 106(4):764-70. . Bell NJ, Burget D, Howden CW. Appropriate acid suppression for the management of gastro-oesophageal reflux disease. Digestion . 1992. 51 Suppl 1:59-67. . Berenson GA, Wyllie R, Caulfield M. Intralesional steroids in the treatment of refractory esophageal strictures. J Pediatr Gastroenterol Nutr . 1994 Feb. 18(2):250-2. . Botoman VA, Surawicz CM. Bacteremia (...) . 1991 Nov-Dec. 37(6):650-1. . Heller SR, Fellows IW, Ogilvie AL. Non-steroidal anti-inflammatory drugs and benign oesophageal stricture. Br Med J (Clin Res Ed) . 1982 Jul 17. 285(6336):167-8. . Kadakia SC, Parker A, Carrougher JG. Esophageal dilation with polyvinyl bougies, using a marked guidewire without the aid of fluoroscopy: an update. Am J Gastroenterol . 1993 Sep. 88(9):1381-6. . Kuo WH, Kalloo AN. Reflux strictures of the esophagus. Gastrointest Endosc Clin N Am . 1998 Apr. 8(2):273-81

2014 eMedicine.com

136. Esophageal Stricture (Treatment)

stenosis in a child. Endoscopy . 2009. 41 Suppl 2:E73. . Vollan G, Stangeland L, Soreide JA. Long term results after Nissen fundoplication and Belsey Mark IV operation in patients with reflux oesophagitis and stricture. Eur J Surg . 1992 Jun-Jul. 158(6-7):357-60. . Wilcox CM, Alexander LN, Clark WS. Localization of an obstructing esophageal lesion. Is the patient accurate?. Dig Dis Sci . 1995 Oct. 40(10):2192-6. . Wilkins WE, Ridley MG, Pozniak AL. Benign stricture of the oesophagus: role of non (...) fundoplication), esophageal lengthening with antireflux surgery (Collis-Nissen or Belsey gastroplasty) Esophageal resection and reconstruction - Gastric or colon interposition or jejunal segment If the benign peptic stricture is dilatable, an esophageal-sparing operation is performed. Note the following: If the length of the esophagus is normal, standard antireflux surgery and postoperative dilation as necessary is recommended. If the esophagus is short, performing Collis gastroplasty and postoperative

2014 eMedicine.com

137. Esophageal Webs and Rings (Treatment)

, cutting solid food into smaller pieces, and eating slowly. Before patients take oral medications, warn patients of the hazard of pills lodging in their esophagus; hence, they should cut large sized pills into smaller pieces prior to ingestion when possible. In addition, instruct patients to drink at least 8 ounces of liquid and to avoid laying supine for at least 30 minutes after taking their oral medications. These precautionary measures may prevent pill-induced esophagitis even in patients without (...) passage of a single Maloney bougie (46-58F), regardless of ring rupture. [ ] However, repeat dilation is safe and effective. Unlike the lower esophageal rings, patients with multiple esophageal rings follow a set of different therapeutic rules for esophageal dilation. This recommendation is based on the author's cumulative experience with this rare condition. The esophageal lumen in patients with multiple esophageal rings is typically much narrower than in patients with lower esophageal rings. Medical

2014 eMedicine.com

138. Esophageal Varices (Treatment)

thirds of the stomach, with staple gun transection of the lower esophagus) (eg, splenectomy, gastroesophageal devascularization, and esophageal transection [at times]). The incidence of liver failure and encephalopathy is low following devascularization procedures, presumably because of better maintenance of portal flow. However, these procedures are rarely performed but may have a role in patients with portal and splenic vein thrombosis who are not suitable candidates for shunt procedures and who (...) -pump inhibitor for 10 days after EVL can reduce the size of these ulcers. [ ] Previous Next: Treatment Complications Complications related to the therapeutic procedures used in management of bleeding esophageal varices include the following: Balloon tamponade - Aspiration pneumonia, esophageal perforation, superficial lesions of the gastric mucosa, and pressure necrosis of the nasal passages, mouth, or lips Sclerotherapy - Perforation of the esophagus (2-6%), esophageal ulceration and bleeding (2

2014 eMedicine.com

139. Esophageal Hematoma (Treatment)

of the esophageal wall have been reported during endoscopy of an esophageal hematoma. Previous References Freeman AH, Dickinson RJ. Spontaneous intramural oesophageal haematoma. Clin Radiol . 1988 Nov. 39(6):628-34. . Adeonigbagbe O, Khademi A, Washington M. Spontaneous esophageal hematoma. Am J Gastroenterol . 1999 Dec. 94(12):3655. . Chen TA, Lo GH, Lai KH. Spontaneous rupture of iatrogenic intramural hematoma of esophagus during endoscopic sclerotherapy. Gastrointest Endos . 1999 Dec. 50(6):850-1. . Hiller N (...) secondary to anticoagulation therapy for mitral valve replacement. J Card Surg . 2016 Dec. 31(12):740-741. . Marks IN, Keet AD. Intramural rupture of the oesophagus. Br Med J . 1968 Aug 31. 3(617):536-7. . Yamashita S, Takeno S, Moroga T, et al. Successful treatment of esophageal repair with omentum for the spontaneous rupture of the esophagus (Boerhaave's syndrome). Hepatogastroenterology . 2012 May. 59(115):745-6. . Yin A, Li Y, Jiang Y, Liu J, Luo H. Mallory-Weiss syndrome: clinical and endoscopic

2014 eMedicine.com

140. Esophagitis (Diagnosis)

distinguish eosinophilic esophagitis from gastroesophageal reflux disease. Clin Gastroenterol Hepatol . 2009 Dec. 7(12):1305-13; quiz 1261. . . Howden CW, Hornung CA. A systematic review of the association between Barrett's esophagus and colon neoplasms. Am J Gastroenterol . 1995 Oct. 90(10):1814-9. . Uygun I. Caustic oesophagitis in children: prevalence, the corrosive agents involved, and management from primary care through to surgery. Curr Opin Otolaryngol Head Neck Surg . 2015 Dec. 23 (6):423-32 (...) on the underlying disease. Esophagitis is commonly seen in adults and is uncommon in childhood. Infectious esophagitis. Candida esophagitis. Double-contrast esophagram shows linear plaquelike lesions in the esophagus, with normal intervening mucosa. Signs and symptoms The history and physical examination findings vary according to the type of esophagitis present. Symptoms of reflux esophagitis (the most common type) may include the following: Heartburn, or dyspepsia (the most common symptom) Water brash

2014 eMedicine Emergency Medicine

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