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Management of Esophageal Perforation after Foreign Body Removal from the Esophagus via Rigid Esophagoscopy

机译:硬食管镜清除食管异物后食管穿孔的处理

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Herein, we present the case of a 45-years-old woman with a foreign body (dental prosthesis) ingestion lodged in the esophagus(Figure.1). The foreign body was extracted by rigid esophagoscopy after severe manipulation. In 24 hours, the patient became febrile with emphysema in the neck. laboratory data showed leukocytosis and CT scan revealed signs of esophageal perforation(Figure.2). Surgical exploration and drainage of the neck and mediastinum performed through a collar incision in the neck extended to the anterior of SCM in both sides, but we didn't perform feeding jejunostomy. We inserted one corrugated drain in every side of the neck(Figure.3).Patient was NPO for two weeks and brief total parenteral nutrition (TPN) provided her calory.Finally,we succeeded to fistulized the perforation to the skin and control the mediastinitis(Figure.4).Patient regained oral feeding gradually after two weeks NPO. The follow-up esophagogram revealed the passage of the contrast to the distal esophagus with no leak and fistula.Early recognition of perforation could interrupt major operation to control catastrophic complication.
机译:本文中,我们介绍了一个45岁的女性,食管中有异物(假牙)摄入(图1)。严格操作后,通过硬性食管镜抽出异物。在24小时内,患者发热,颈部出现肺气肿。实验室数据显示白细胞增多,CT扫描显示有食管穿孔迹象(图2)。颈部和纵隔的外科探查和引流是通过在颈部两侧延伸至SCM前方的颈环切口进行的,但我们没有进行空肠吻合术。我们在颈部的每一侧插入一个波纹状的引流管(图3)。患者接受NPO治疗两周,短暂的全肠外营养(TPN)提供了热量。最后,我们成功地对皮肤穿孔进行了瘘管并控制了纵隔炎。 (图4).NPO两周后患者逐渐恢复了口服喂养。后续的食管造影检查显示了与远端食管的对比通过,没有渗漏和瘘管。早期认识到穿孔会中断大手术以控制灾难性并发症。

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