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The oesophagus.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Oesophageal duplication cysts are similar to 'bronchogenic' and 'neurenteric' cysts - see p. 3.13 -14. Most do not present until adulthood, and the majority are incidental findings. Symptomatic cases may have dysphagia, epigastric discomfort, retrosternal pain or a cough; ulceration, haemorrhage, infection and/ or rupture may occur leading to mediastinitis. empyema or pyopericardium.
Thoracic trauma
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
The management of esophageal injury is largely dependent on the timing of the injury and underlying status of the patient. For relatively “fresh” injuries, typically defined as those occurring within 24 hours of presentation, primary repair is indicated. This repair may constitute direct repair of the esophagus in a single layer, or direct repair with pleural flap cover. For those patients presenting more than 24–48 hours after injury, operative repair is not indicated and treatment should be directed toward the management of mediastinitis by means of mediastinal drainage, IV antibiotics, and parenteral nutrition. In cases of severe injury complicated by mediastinitis, management may also include esophageal diversion in order to limit ongoing mediastinal contamination.
Post-Esophagectomy (for Esophageal Cancer) Neck Leak
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
W.K. Ooi, S.M. Lagarde, B.P.L. Wijnhoven
Clinical features, together with a raised leukocyte and C-reactive protein level in the patient on day three to four after surgery, were suggestive of all complications including anastomotic leakage. Although the neck wound appeared normal and there were no clinical signs of pneumonia. Our initial assessment was focused on ruling out an anastomotic leak (with an intrathoracic manifestation) as this needs early treatment. The first diagnostic test we favor is a CT thorax with oral contrast. Although the sensitivity and specificity may be high, in our patient this appeared to be falsely negative. Hence an endoscopy was performed given the high index of suspicion for a leak. Endoscopy has better specificity and sensitivity compared to contrast swallow in detecting a leak and simultaneously permits assessment for conduit ischemia, which was negative in this patient. Despite that, the patient’s clinical condition did not improve and thus a reassessment by CT scan was carried out. This CT scan showed features of mediastinitis (the presence of mediastinal free air and fluid (Figure 7.1).
Impact of microbial findings on plastic reconstructive surgery outcomes in patients with deep sternal wound infection after cardiac surgery
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Annika Arsalan-Werner, Linda Dick, Mani Arsalan, Olaf Wölfle, Thomas Walther, Michael Sauerbier
Deep sternal wound infection (DSWI) is a life-threatening complication after median sternotomy with an incidence of 0.75–8% [1–4]. According to the guidelines of the Center of Disease Control and Prevention in the USA [5], the diagnosis requires at least one of the following (1) an organism isolated from culture of mediastinal tissue or fluid, (2) evidence of mediastinitis seen during operation, (3) one of the following conditions: chest pain, sternal instability or fever (>38 °C), in combination with either purulent discharge from the mediastinum or an organism isolated from blood culture or culture of mediastinal drainage. The pathogenesis of DSWI is multifactorial, risk factors include obesity, diabetes mellitus, usage of bilateral internal thoracic artery grafts and previous heart surgery [1,2,4]. Although the epidemiology and risk factors of DSWI are well known, the optimal treatment strategy and especially the appropriate timing of final wound closure remains controversial and no official current guidelines exist.
Prehospital Laryngeal Tube Airway Device Placement Resulting in Hypopharyngeal Perforation: A Case Report
Published in Prehospital Emergency Care, 2020
Matthew Chinn, Lynda Biedrzycki
Hypopharyngeal or esophageal injuries from laryngeal tube airways, or any airway device, are of significance given their potential for serious and sometimes lethal complications. Perforation of the pyriform sinus has been described as an iatrogenic source of injury from airway management procedures, transesophageal echocardiography, and nasogastric tube placement among others (1, 5, 6). It is a rare, but potentially fatal, injury that must be recognized. Complications include mediastinal emphysema, hematoma or mediastinitis, pneumothorax, retropharyngeal abscess, and resultant sepsis. Treatment is controversial and ranges from medical therapy to surgical options (5). Esophageal perforation is a related condition and extremely rare with an estimated 3.1/1,000,000 population per year (7). Iatrogenic causes are implicated in around 70% of esophageal perforation cases. Iatrogenic etiologies include endoscopic procedures, endotracheal intubation, other airway management device placement, nasogastric tube placement, and transesophageal echocardiography, among others. Patients usually present with pain (80%). Other symptoms include nausea and vomiting, hematemesis, dysphagia, tachypnea, cough and fever. Subcutaneous emphysema and pneumothorax or hemothorax are other signs. Mortality after esophageal perforation is reported at 10–25% with early recognition and even higher if delayed; iatrogenic injuries tend to have lower mortality rates than other causes. Treatment can be nonoperative or operative depending on the specific injury (8). The follow discussion will focus on injuries associated with placement of laryngeal tube airways.
Minimally Invasive Tricuspid Valve Replacement in a Patient with Behcet Disease
Published in Structural Heart, 2020
Mohamed Alaa Nady, Mohamed Eladel
Conclusions: Mini invasive tricuspid valve replacement via periareolar approach is safe, feasible, and effective in immunocompromised, corticosteroid dependent patients. Mini invasive surgery is much beyond cosmetic satisfaction and life quality, sometimes it is very advantegous to save the patients the dismal complication of mediastinitis particularly in immunocompromised patients as in our case here.