c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Esophageal Perforation: 16

A D V E R T I S E M E N T

   
 

The second esophageal tear was sutured with fine material.       

Notes:

Link to this frame from your Personal Thumbnails page? Yes No


 

Esophageal Perforation: 17

A D V E R T I S E M E N T

   
 

The intercostal muscle pedicle was sutured against the second repair as a buttress. The non-periosteal side of the pedicle was placed against the esophagus and the pedicle was not wrapped circumferentially so that periosteal calcium deposition would not constrict the esophagus.

The patient was able to be extubated on day 5 following the second surgery. The patient was discharged to a nursing facility and from there to home. Initial dysphagia from edema resolved with time.

Comments:

1. The esophagus is a fragile and unforgiving organ, especially in a frail elderly patient. It must be treated with great care and respect.

2. Strategies for avoiding esophageal injury include wire-guided bougie passage, with the wire placed endoscopically; use of the softest flexible-tipped bougie available (currently tungsten filled, mercury is no longer being used); avoidance of angulation of the esophagus with the Penrose; passage of a smaller (36 Fr..) bougie alongside an 18 Fr.. nasogastric tube; and most important, an experienced operator passing the bougie.

3. Early identification of the injury is imperative. Once the patient becomes septic and the esophageal wall becomes macerated, it is very difficult to salvage the situation. 

Notes:

Link to this frame from your Personal Thumbnails page? Yes No


 

Click the "Update" button to save your Notes and Personal Thumbnails.

 

Thumbnails

This page was last modified on 5/26/2000.