George John K Thomas George
PRINCE COURT MEDICAL CENTRE , KUALA LUMPUR, Malaysia
Date, time and location: 2018.05.25 13:30, Congress Hall, 2F–C
Abstract
ESOPHAGEAL PERFORATION AS A RESULT OF DELAYED DIAGNOSIS POSES A SERIOUS THREAT TO THE PATIENT AS WELL AS DIFFICULTY IN TREATING THE CONDITION SUCCESSFULLY BY SURGEONS DUE TO ITS HIGH MORTALITY AND MORBIDITY. MORTALITY RATE RANGES FROM 30 TO 50% AND CAN EVEN GO AS HIGH AS 70% DEPENDING UPON TIME OF PRESENTATION BY PATIENT TO THE HOSPITAL AND EXTENT OF SEPSIS . WE PRESENT TWO SUCH CASES WHERE SUCCESSFUL TREATMENT WAS DONE USING T TUBE FOR CLOSURE OF PERFORATION .
FIRST CASE IS A PENETRATING STAB INJURY TO NECK AND UPPER CHEST WHEREBY DIAGNOSIS OF PERFORATION WAS MADE AFTER 72HOURS. PATIENT CAME IN WITH RIGHT EMPYEMA THORACIS WITH A 2CM TEAR IN UPPER THORACIC ESOPHAGUS. THE SECOND PATIENT HAD A PERFORATION SECONDARY TO OESOPHAGEAL DILATATION FOR ACHALASIA CARDIA BUT MISSED DIAGNOSIS AND PATIENT CAME IN 2 WEEKS LATER WITH GROSS LEFT SIDED EMPYEMA THORACIS , LUNG COLLAPSE WITH MEDIASTINITIS . THIS PATIENT HAD A 4CM LONGITUDINAL TEAR AT LOWER OESOPHAGUS CLOSE TO CARDIO-ESOPHAGEAL JUNCTION. DIAGNOSIS WERE CONFIRMED RADIOLOGICALLY IN BOTH PATIENTS. BOTH PATIENTS UNDERWENT THORACOTOMY , DECORTICATION , ESOPHAGEAL DEBRIDEMENT AND T TUBE WERE INSERTED INTO THE PERFORATION AS A CONTROLLED FISTULA. BOTH PATIENTS WITH TWO DIFFERENT LEVELS OF ESOPHAGEAL PERFORATION WERE MANAGED SUCCESSFULLY WITH T TUBES AND DISCHARGED WELL WITHOUT ANY FURTHER SURGICAL INTERVENTION.
