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Esophageal perforation
- 2. ESOPHAGEAL PERFORATION / INJURIES DR JAMSHEER .VT 2nd year MS PG THANJAVUR MEDICAL COLLEGE
- 3. INTRODUCTION • LACK OF SEROSA- EASY PERFORATION • CHARECTERISTIC ANATOMICAL LOCATION-NOT COMMONLY INJURED IN BLUNT INJURY
- 4. • DELAY IN DIAGNOSIS - PRESENTATION SIMILAR TO OTHER VARIOUS MEDICAL AND SURGICAL ILLNESSES - ONE OF MOST LETHAL GASTROINTESTINAL PERFORATION • INCIDENCE IS TOO LOW • MORTALITY IS TOO HIGH
- 5. ETIOLOGY • INSTRUMENTATION MOST COMMON • TRAUMA • SPONTANEOUS
- 6. OTHER • SURGICAL • FOREIGN BODY • MALIGNANCY • PEPTIC ULCER • OPERATIVE INJURY • HSV/HIV/TB
- 7. PILL ESOPHAGITIS • NSAID • KCl • OSTEOPOROSIS-ALENDRONATE • MINO/DOXYCYCLIN
- 8. FOREIGN BODY • ADULT-FISH MEAT BONE • PAEDIATRIC • NON CORROSIVE & SMALL - WAIT IF PASS CRICOPHARYNX • LITHIUM BATTERY – WAIT IF PASS BEYOND LOWER ESOPHAGEAL SPHINTURE • EMERGENCY IF IN ESOPHAGUS
- 9. COMMON ANATOMICAL LOCATION • INSTRUMENTATION - CRICOPHARYNX • DILATATION – AT/PROXYMAL TO LESION • FOREIGN BODY - CRICOPHARYNX • CAUSTIC – NEAR LES
- 10. SPONTANEOUS PERFORATION • BOERHAAVES SYNDROME • COMPLETE DISRUPTION OF WALL IN THE ABSENCE OF PRE-EXISTING PATHOLOGY • FIRST 1723- 200YEARS NO CURE • LOCATION – LOWER 3RD • MALE & ALCOHOLIC
- 11. CAUSES • RETCHING/VOMITING • BLUNT TRAUMA • WEIGHT LIFTING • PARTURITION • DEFECATION • STATUS EPILEPTICUS
- 12. CLINICAL FEATURES DEPENDS ON • TIME SINCE INJURY • SITE OF LESION • SIZE OF LESION • MOST IMPORTANT EVENT-PRIOR SEVERE VOMITING
- 13. MACKLER’S TRIAD • VOMITING / RETCHING • SEVERE CHEST PAIN • SUBCUTANEOUS EMPHYSEMA • CLASSICALLY SEEN IN 12% • COMPLETELY ABSENT IN 22% • SO NOT AT ALL RELAIBLE
- 15. EARLIEST SIGN
- 16. CLINICAL FEATURES • CHEST PAIN • FEVER • TACHYCARDIA • TACHYPNOEA
- 17. DIAGNOSIS • CHARECTERISTIC CLINICAL FEATURES • RADIOLOGY
- 18. DELAY IN DIAGNOSIS • DUE TO CLOSE SIMILARITY BETWEEN OTHER MEDICAL & SURGICAL CONDITIONS LIKE
- 19. MEDICAL • MYOCARDIAL INFARCTION • PERICARDITIS • SPONTANEOUS PNEUMOTHORAX • PNEUMONIA • MALLORY WEISS TEAR…..
- 20. SURGICAL • PERITONITIS • ACUTE PANCREATITIS • PERFORATED PEPTIC ULCER • AORTIC ANEURYSM (LEAK/RUPRTURE) • BILIARY COLIC / RENAL COLIC • MESENTERIC ISCHEMIA
- 21. INVESTIGATION • XRAY – IF FAILS GASTROGRAFFIN IF FAILS- THIN BARIUM IF FAILS CT IF FAILS ENDOSCOPY
- 22. PLAIN X-RAY
- 24. C T
- 25. • CT • INDICATION • USES- POST OP FOLLOW UP OF IMPROVEMENT
- 26. ENDOSCOPY – BLUNT INJURY
- 27. TREATMENT • INITIAL RESUSCITATION • NON OPERATIVE • OPERATIVE
- 28. INITIAL RESCUCITATION • MONITOR VITALS. • SPo2 • URINE OUTPUT • OPIATE BASED ANALGESIA • ANTIBIOTIC. • PROTON PUMP INHIBITORS • NPO/NASOGASTRIC TUBE • TUBE THORACOSTOMY.
- 29. NON OPERATIVE • ICU • CT GUIDED ASPIRATION • NASO GASTRIC WASH • FEEDING JEJUNOSTOMY
- 30. SURGERY • AIM-MOST IMPORTANT –THOROUGH DEBRIDEMENT • THEN REPAIR • FEEDING JEJUNOSTOMY
- 31. PRIMARY REPAIR & REINFORCEMENT • MYOTOMY • SINCE MUCOSAL LESION MORE THAN MUSCLE
- 35. T-TUBE REPAIR • DELAYED BUT TOLERATED PATIENT • PRINCIPLE – MAKE CONTROLLED ESOPHAGO CUTANEOUS FISTULA • SERIAL CT • VIABLE OPTION FOR ALL PERFORATION
- 38. IATROGENIC PERFORATION • ENDOSCOPY & SURGICAL • ANATOMICAL SITE- CRICOPHARYNX • STENT PLACEMENT CARRY A RISK OF ABOUT 5-25% • HIGHEST
- 39. MANAGEMENT • SINCE PATIENT IS IN NPO IS VERY LOW CONTAMINATION
- 40. Cameron’s criteria – NON OPERATIVE
- 41. Shaffer - NON OPERATIVE
- 44. CAUSTIC INJURIES • ADULT SUICIDAL – MORE INJURY • CHILDHOOD – ACCIDENTAL LESS INJURY • ACID –CHARRING – PREVENT FURTHER PROGRESSION • ALKALI – LIQIFACTIVE NECROSIS – TRANSMURAL INVOLVEMENT
- 45. INVESTIGATION • CHEST X-RAY • EARLY FLEXIBLE SCOPY • RESPIRATORY COMPROMISE/PERFORATION • ESOPHAGEAL ENDOSONOGRAPHY
- 46. GRADE FINDING 1 MUCOSAL EDEMA / HYPEREMIA 2 EROSION/EXUDATES 3 NECROSIS
- 47. FIRST 1723-200
- 48. FUTURE COMPLICATION • STRICTURE • MALIGNANCY
- 49. •THANK YOU