tailieunhanh - Báo cáo y học: "Oesophageal Perforation: A diagnostic and therapeutic challenge in a resource limited setting. A report of three cases."

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Oesophageal Perforation: A diagnostic and therapeutic challenge in a resource limited setting. A report of three cases. | Balumuka et al. Journal of Cardiothoracic Surgery 2011 6 116 http content 6 1 116 JCTS JOURNAL OF CARDIOTHORACIC SURGERY CASE REPORT Open Access Oesophageal Perforation A diagnostic and therapeutic challenge in a resource limited setting. A report of three cases Deo D Balumuka1 Phillipo L Chalya2t and William Mahalu1t Abstract Background Oesophageal perforation is a condition associated with a high mortality. Its management is still controversial with operative treatment being favoured but a shift to conservative management is occurring. Very little exists in medical literature about its management in Sub-Saharan Africa where the paucity of thoracic surgeons is compounded by limited diagnostic and therapeutic facilities. Case Presentation We report three cases of oesophageal perforation which were all treated conservatively with tube thoracostomy nil by mouth with feeding gastrostomy intravenous antibiotics and chest physiotherapy. Two patients achieved oesophageal healing but one died due to severe septicaemia. Conclusion In a resource restricted setting conservative management which includes enteral nutrition by feeding gastrostomy tube thoracostomy to drain inter pleural contaminants intravenous antibiotics and chest physiotherapy is a safe and effective treatment for oesophageal perforations. Background Oesophageal perforation is an uncommon but potentially fatal injury that can quickly progress to mediastinitis sepsis and multiorgan failure if early recognition and proper treatment is not instituted 1 . The commonest cause of oesophageal perforation is instrumentation. The frequent use of upper gastrointestinal fiberoptic endoscopy has led to an increase in the actual number of perforations 2 . The most common area of perforation is in the region of the cricopharyngeus muscle. The oesophageal inlet is the narrowest area of the oesophagus and the cricopharyngeus muscle contributes to the decrease in diameter of the lumen 2 . The .