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Oesophageal emergencies

Oesophageal emergencies. Pál Ondrejka Professor of Surgery. Emergency oeasophageal disorders. Perforation Iatrogenic perforation Spontaneous perforation Boerhaave ’s syndrome Traumatic perforation Blunt trauma Penetrating injuries Foreign body Caustic injuries Alcalic Acidic.

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Oesophageal emergencies

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  1. Oesophagealemergencies Pál Ondrejka Professor of Surgery

  2. Emergencyoeasophagealdisorders • Perforation • Iatrogenicperforation • Spontaneousperforation • Boerhaave’ssyndrome • Traumaticperforation • Blunt trauma • Penetratinginjuries • Foreign body • Causticinjuries • Alcalic • Acidic

  3. Whytheoesophagealinjuriesarehighlyproblematic? • The proximity of vitalstructures • The bloodsuply • The lack of serosalsurfacearroundtheorgan • The injuriesarecarryhighmorbidity and mortality • Most surgeons has limited experienceswithdiagnosis and treatment of suchcases

  4. Hermann Boerhaave(31 December 1668 – 23 September 1738)[

  5. Boerhaave syndrome • Boerhaave first described Boerhaave syndrome, which involves tearing of the oesophagus, usually a consequence of vigorous vomiting. He notoriously described in 1724 the case of Baron Jan van Wassenaer, a Dutch admiral who died of this condition following a gluttonous feast and subsequent regurgitation.[8] This condition was uniformly fatal prior to modern surgical techniques allowing repair of the oesophagus.

  6. Aetiology • Suddenrise of intra-abdominalpressure (80-90%) • Vomitingorretching • Blunt trauma • Weightlifting • Defecation • Heimlich manoeuvre • Status epilepticus

  7. Existingunderlyingoesophagealdisorders (10-20%) • Malignancy • Pepticulceration • Herpessimplexvirus (HSV) • Human immunodeficiencyvirus (HIV) • Tuberculosis (TB)

  8. Tipicallocation • Justabovethediaphragm • Leftposterolateralposition • Usuallysingl, longitudinal, 1-8 cm • Men : women = 4 . 1 • Medianage 64 years • Most of thambecauseofalcoholicintoxication • Pleuraldisruptiondevelopesbarogenicallyorfrom rapid gastricaciderosion

  9. Mackler’striadofclinicalpresentation of oesophagealperforation • Vomitingorretching • Chestpain (Sudden and dramatic) constant, epigastricorretrosternal, exacerbatedbymovement • Subcutaneousemphisema (takesabout an hourtodevelop)

  10. Othersymptomes • Tachycardia, tachypnoe • The patienttakessitingpositioninordertoreducediaphragmaticmovements • Patientsarepale and sweaty • Coolperipheries • Chemicalpleuromediastinitisdevelops • In 24.48 hourscardiopulmanaryinsuffitientydevelops

  11. Diagnosticexaminations • Plainchest and abdominalradiography • Contrastradiography • Uppergastrointestinalendoscopy • Computedtomography (CT) • Other • Pleuralaspiration • Oralbluedyes

  12. Plainchestradigraphy

  13. Tipicalchestradiographyfindings • Pleuraleffusion • Pneumomediastinum • Sucutaneousemphysema • Hydropneumothorax • Pneumothorax

  14. Preoperativeresustitation • Control of airway and administration of O2 • Earlyanaestheticinvolvment • Stabilecentralintravenosusaccess • Urethralcatether • Broadspectrumantibiotic and antifungalagents • Intravenosusantisecretorydrugs • Zerodiet • Intercostalchestdrainage • Nasogastrictube

  15. Contrastradiograpy

  16. Endoscopicexamination

  17. CT scan

  18. Frequentmedicalmisdiagnoses • Myocardialinfarction • Pericarditis • Spontaneouspneumothorax • Pneumonia • Oesophagealvarices/mallory-Weistear • Mesentericischaemia

  19. Frequentsurgicalmisdiagnoses • Peritonitis • Acutepancreatitis • Perforatedpepticulcer • Renalcoloc • Aorticaneurism (dissection/rupture) • Billiarycolic • Mesentericischaemia

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