Successful Surgical Treatment of a Spontaneous Rupture of the Esophagus Diagnosed Two Days after Onset

Esophageal perforation is a relatively uncommon disease with a high rate of mortality and morbidity. Delay in the diagnosis and treatment occurs in more than 50% of cases, leading to a mortality rate of 40–60%. Primary repair is generally considered the gold standard for patients who present within the first 24 h following perforation of the esophagus. In this paper, we present a case of successful surgical treatment of spontaneous rupture of the esophagus that was diagnosed 2 days after onset. The patient was a 42-year-old man admitted to internal medicine with a diagnosis of pleuritis and complaining of chest and back pain. The next day, computed tomography revealed left-sided pleural effusion and mediastinal emphysema. An esophagogram revealed extravasation of the contrast medium from the lower left esophagus to the mediastinal cavity. These results confirmed a rupture of the esophagus, and an emergency left thoracotomy was performed. The perforation was repaired with a single-layered closure and was covered with elevated great omentum obtained by laparotomy. The patient was discharged 23 days after the first surgery. In conclusion, primary repair surgery must be selected as the best treatment beyond 24 h if the patient's general state was stable and there was no evidence of clinical sepsis

New approach to surgical management of early eophageal thoracic perforation: Primary suture repair reinforced with absorbable mesh and fibrin glue

Esophageal perforation is a life-threatening situation and represents a major therapeutic challenge. Results have improved in recent years particularly as a result of progress in antibiotic therapy and the use of total parenteral nutrition. Surgical management retains a predominant role, involving early primary closure and thoracic drainage. We have made an addition to the surgical management by applying an absorbable mesh and fibrin glue to the repaired site. Seven patients (ages 38-79 years) were treated as described. The mean interval from leak to surgery was 28 hours. Six patients had an uneventful postoperative course with a mean hospital stay of 34 days (range 26-45 days). In one case the technique failed and the patient required an exclusion-diversion procedure. All 7 patients recovered without mortality. We believe that this technique provides a real improvement for this precarious esophageal repair

Total pancreatectomy and subtotal duodenopancreatectomy for the management of carcinoma of the head of the pancreas: an institutional experience and evolving trends.

This retrospective study includes 88 consecutive patients treated by surgical resection for adenocarcinoma of the head of the pancreas between January 1973 and December 1992. Initially in 1973 total pancreatectomy was the treatment of choice. Our policy changed after a review of 47 consecutive total pancreatectomies in 1986 which showed no benefit. From 1986 the Whipple procedure became our standard operation. In the following 41 patients, a Whipple procedure was performed in 19 patients, and a total pancreatectomy was still performed in 22 patients because of positive resection margins or a friable pancreatic remnant. After total pancreatectomy, the 5-year survival rate was 7.8%. For lymph-node-negative patients, the 1-, 3-, and 5-year survival rates were 54, 24, and 15%, respectively. For node-positive patients, the 1-and 3-year survival rates were 46 and 4%, respectively, and there were no survivors at 54 months. This difference was statistically not significant. After the Whipple procedure, the 5-year survival rate was 12.5%. For node-negative patients, the 1-, 3- and 5-year survival rates were 50, 59, and 25%, respectively. For node-positive patients, the 1-year survival rate was 21%. This difference was significant (p = 0.007). This study highlights the fact that extended radical surgery does not improve overall survival, but stage II and III disease (Hermreck classification) was associated with a prolonged survival. © 1996 S. Karger AG, Basel

Venous allografts: a useful alternative to venous autografts in digestive surgery

Over a 16 month period seven patients underwent surgery using venous allografts either to reconstruct the portal vein, or to construct a mesocaval 'H' graft or a shunt between the coronary vein and the subhepatic inferior vena cava. The allografts were harvested during multiorgan procurement from the bifurcation of the inferior vena cava, the common iliac vein and the external iliac vein and kept in a preservation solution at 4 degrees C for a mean time of 6 days (range 1-29) before use. Subsequent thrombosis was clinically evident in only two patients. The use of venous allografts appears to be a useful alternative to other venous replacements

Intrahepatic hematoma following needle biopsy of liver graft: incidence and management

Percutaneous liver biopsy is a frequently used technique to diagnose hepatic allograft dysfunction after liver transplantation. One hundred and twenty-four grafts were biopsied under ultrasound control with 5 patients developing hepatic hematomas,3 subcapsular and intrahepatic, 1 only subcapsular and 1 only intrahepatic. All were managed by conservative treatment and followed by ultrasound and computed tomography scanning without rupture, infection or deleterious effect on the liver allograft. Surgical or radiological drainage in this group of patients was not necessary. © 1997 S. Karger AG, Basel