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Takashi Kamei - One of the best experts on this subject based on the ideXlab platform.

  • acute esophageal necrosis with Esophagus Perforation treated by thoracoscopic subtotal esophagectomy and reconstructive surgery on a secondary esophageal stricture a case report
    Surgical Case Reports, 2019
    Co-Authors: Ryujiro Akaishi, Yusuke Taniyama, Tadashi Sakurai, Hiroshi Okamoto, Chiaki Sato, Michiaki Unno, Takashi Kamei
    Abstract:

    Acute esophageal necrosis is defined as necrosis of the esophageal mucosa causing diffuse black pigmentation of the Esophagus, the so-called black Esophagus from its endoscopic findings. The prevalence is only 0.001~0.2%, while its mortality rate is up to 32%. However, most of the cases are fatal by comorbidities. A 67-year-old female with diabetes mellitus was transported to the emergency room with hematemesis and disordered consciousness. She had suffered from nausea and epigastralgia for 2 days. The patient’s general status was shock evidenced by vital signs, and she did not respond to rehydration. After intubation, emergency endoscopic examination revealed black pigmentation of the esophageal mucosa, and the condition was diagnosed as acute esophageal necrosis. Antibiotics and plasmapheresis had been started, and the patient gradually stabilized. One week after the admission, Esophagus Perforation was suspected from the significant increase of the right pleural effusion and free air at the Esophagus wall and the mediastinum on CT scan. Emergency thoracoscopy revealed an edematous Esophagus which was colored black. Esophagectomy with esophagostomy and enterostomy was performed. On resected specimen, mucosal necrosis was found only on the squamous epithelium, with three perforating areas in the middle to lower thoracic Esophagus. No signs of inflammation or ischemia were found on the gastric mucosa of the esophagogastric junction. After the operation, the patient recovered generally well, except for the severe stenosis of the cervical Esophagus. Cervical esophagectomy, tracheotomy, and anterior thoracic route reconstruction with free jejunum interposition and gastric tube were performed 9 months after the first surgery. No postoperative complications occurred; on the 37th day after the operation, the patient was eating well and was transferred to continue swallowing rehabilitation. It is important to detect the Esophagus Perforation and mediastinitis early and thereby not to miss the chance of surgical intervention to save the patient’s life. Surgery should be minimized, and reconstruction should be considered next. If the cervical Esophagus is also affected, reconstruction surgery should be performed by removing cervical Esophagus and anastomosing it to the hypopharynx using a gastric tube and free jejunum interposition as needed.

  • Acute esophageal necrosis with Esophagus Perforation treated by thoracoscopic subtotal esophagectomy and reconstructive surgery on a secondary esophageal stricture: a case report
    SpringerOpen, 2019
    Co-Authors: Ryujiro Akaishi, Yusuke Taniyama, Tadashi Sakurai, Hiroshi Okamoto, Chiaki Sato, Michiaki Unno, Takashi Kamei
    Abstract:

    Abstract Background Acute esophageal necrosis is defined as necrosis of the esophageal mucosa causing diffuse black pigmentation of the Esophagus, the so-called black Esophagus from its endoscopic findings. The prevalence is only 0.001~0.2%, while its mortality rate is up to 32%. However, most of the cases are fatal by comorbidities. Case presentation A 67-year-old female with diabetes mellitus was transported to the emergency room with hematemesis and disordered consciousness. She had suffered from nausea and epigastralgia for 2 days. The patient’s general status was shock evidenced by vital signs, and she did not respond to rehydration. After intubation, emergency endoscopic examination revealed black pigmentation of the esophageal mucosa, and the condition was diagnosed as acute esophageal necrosis. Antibiotics and plasmapheresis had been started, and the patient gradually stabilized. One week after the admission, Esophagus Perforation was suspected from the significant increase of the right pleural effusion and free air at the Esophagus wall and the mediastinum on CT scan. Emergency thoracoscopy revealed an edematous Esophagus which was colored black. Esophagectomy with esophagostomy and enterostomy was performed. On resected specimen, mucosal necrosis was found only on the squamous epithelium, with three perforating areas in the middle to lower thoracic Esophagus. No signs of inflammation or ischemia were found on the gastric mucosa of the esophagogastric junction. After the operation, the patient recovered generally well, except for the severe stenosis of the cervical Esophagus. Cervical esophagectomy, tracheotomy, and anterior thoracic route reconstruction with free jejunum interposition and gastric tube were performed 9 months after the first surgery. No postoperative complications occurred; on the 37th day after the operation, the patient was eating well and was transferred to continue swallowing rehabilitation. Conclusion It is important to detect the Esophagus Perforation and mediastinitis early and thereby not to miss the chance of surgical intervention to save the patient’s life. Surgery should be minimized, and reconstruction should be considered next. If the cervical Esophagus is also affected, reconstruction surgery should be performed by removing cervical Esophagus and anastomosing it to the hypopharynx using a gastric tube and free jejunum interposition as needed

  • PS01.110: ACUTE NECROTIZING ESOPHAGITIS WITH Esophagus Perforation, TREATED BY THORACOSCOPIC ESOPHAGECTOMY
    Diseases of the Esophagus, 2018
    Co-Authors: Ryujiro Akaishi, Yusuke Taniyama, Tadashi Sakurai, Takahiro Heishi, Hiroshi Okamoto, Chiaki Sato, Kai Takaya, Shota Maruyama, Takashi Kamei
    Abstract:

    Abstract Background Acute necrotizing Esophagus is defined as the diffuse black pigmentation of the Esophagus due to the necrosis of the esophageal mucosa, and so called ‘black Esophagus’ from its endoscopic findings. The prevalence is only 0.001∼0.2%, although the mortality rate is up to 32%. Methods 67 years old female with medical history of diabetes mellitus, transported to the emergency room with hematemesis and conscious disorder. She had suffered from nausea and epigastralgia for two days. Her general status was in shock vitals and didn’t respond to rehydration. After intubation, emergency endoscopic examination revealed black pigmentation of the esophageal mucosa and diagnosed as acute necrotizing esophagitis. Antibiotics and blood absorption therapy had been started and the patient gradually stabilized. 1 week after the admission, Esophagus Perforation was suspected from the significant increase of the right pleural effusion and free air at the Esophagus wall and the mediastinum on CT scan. Emergency thoracoscopy was performed and found that the Esophagus was edematous and adventitia was colored into black. The esophagectomy with esophagostomy and enterostomy was performed. Results On resected specimen, mucosal necrosis was found only on squamous epithelium with three perforating areas in the middle to lower thoracic Esophagus. No signs of inflammation nor ischemia was found on the gastric mucosa of the esophagogastric junction. After the operation, patient recovered generally well, except the severe stenosis of the cervical Esophagus had developed. Although endoscopic dilation had been constantly performed, the reconstruction remains unsolved issue. Conclusion In acute necrotizing esophagitis, stabilization of the patient's condition by treating comorbid diseases is extremely important. Improving the nutritional status in addition to the administration of antacids and antibiotics is also required. Surgical intervention should be performed when perforating mediastinitis or abscess formation occurs. Primary closure shouldn’t be attempted, and esophageal resection with delayed reconstruction should be considered in addition to drainage. In this case, we could successfully rescued the patient with necrotic esophagitis by performing surgical intervention promptly. It is important to detect the Esophagus Perforation and mediastinitis early, not to miss the chance of surgical intervention for curative treatment. Disclosure All authors have declared no conflicts of interest.

Bin Ni - One of the best experts on this subject based on the ideXlab platform.

Kyoung-suok Cho - One of the best experts on this subject based on the ideXlab platform.

Francesco Monaco - One of the best experts on this subject based on the ideXlab platform.

  • On a Fatal Case of Candida krusei Pleural Empyema in a Pregnant Woman with Spontaneous Esophagus Perforation
    Mycopathologia, 2010
    Co-Authors: Antonio Cascio, Vincenzo Micali, Chiara Iaria, Demetrio Delfino, Antonio David, Maurizio Monaco, Mario Barone, Francesco Monaco
    Abstract:

    Introduction Candida empyema thoracis can be a consequence of operation, gastropleural fistula, and esophageal Perforation. Case report and review of the literature. A fatal case of a 45-year-old pregnant woman with Candida krusei empyema thoracis secondary to spontaneous Esophagus Perforation associated with candida esophagitis is reported. The case is contextualized among similar cases found through a PubMed search. Conclusions A suspect of Esophagus rupture should arise in the presence of a fungal empyema. Candida esophagitis should be always considered as a possible cause or con-cause of Esophagus rupture. An empirical systemic antimycotic therapy should always be considered in an ideal multidisciplinary approach to the management of patients with Esophagus rupture.

  • on a fatal case of candida krusei pleural empyema in a pregnant woman with spontaneous Esophagus Perforation
    Mycopathologia, 2010
    Co-Authors: Antonio Cascio, Vincenzo Micali, Chiara Iaria, Demetrio Delfino, Antonio David, Maurizio Monaco, Mario Barone, Francesco Monaco
    Abstract:

    Introduction Candida empyema thoracis can be a consequence of operation, gastropleural fistula, and esophageal Perforation. Case report and review of the literature. A fatal case of a 45-year-old pregnant woman with Candida krusei empyema thoracis secondary to spontaneous Esophagus Perforation associated with candida esophagitis is reported. The case is contextualized among similar cases found through a PubMed search.

Quan Zhu - One of the best experts on this subject based on the ideXlab platform.

  • Video-mediastinoscopy assisted fish bone extraction and superior Medistinal abscess debridement.
    Journal of cardiothoracic surgery, 2018
    Co-Authors: Jun Wang, Liang Chen, Quan Zhu
    Abstract:

    Mediastinum abscess caused by sharp esophageal foreign body Perforation usually needs surgical treatment, and the surgical procedures vary according to size of Perforation and scope of abscess, etc. For special case with small esophageal mucosal crevasse and focal abscess confined to mediastinum, minimally invasive surgery with guidance of video-mediastinoscopy would be an alternative method, however, application of video-mediastinoscopy in this life-threatening situation was rarely reported. One patient with detention of fish bone stuck in the Esophagus developed systemic inflammatory response syndrome. Computed tomography results revealed that two high-density foreign bodies migrated extraluminally and caused abscess confined in the mediastinum. Multidisplinary collaborative efforts of anesthesiology, gastroenterology and thoracic surgery were made to optimize the therapeutic process. By taking advantages of wide working channel and better exposure of video-mediastinoscopy, two sharp fish bones were removed with minimal risk of injuring adjacent important tissues, furthermore, complete debridement of the abscess and precise drainage tube indwelling was achieved simultaneously. Postoperative comprehensive therapy including anti-infection and nutrition support guaranteed a smooth transition of perioperative period. This is the first report on application of video-mediastinoscopy in removing two fish bones that migrated extraluminally and debridement of the abscess caused by Esophagus Perforation with minimal injury risk, which offer a safe and effective minimal invasive method for specific cases.

  • Video-mediastinoscopy assisted fish bone extraction and superior Medistinal abscess debridement
    BMC, 2018
    Co-Authors: Jun Wang, Liang Chen, Quan Zhu
    Abstract:

    Abstract Background Mediastinum abscess caused by sharp esophageal foreign body Perforation usually needs surgical treatment, and the surgical procedures vary according to size of Perforation and scope of abscess, etc. For special case with small esophageal mucosal crevasse and focal abscess confined to mediastinum, minimally invasive surgery with guidance of video-mediastinoscopy would be an alternative method, however, application of video-mediastinoscopy in this life-threatening situation was rarely reported. Case presentation One patient with detention of fish bone stuck in the Esophagus developed systemic inflammatory response syndrome. Computed tomography results revealed that two high-density foreign bodies migrated extraluminally and caused abscess confined in the mediastinum. Multidisplinary collaborative efforts of anesthesiology, gastroenterology and thoracic surgery were made to optimize the therapeutic process. By taking advantages of wide working channel and better exposure of video-mediastinoscopy, two sharp fish bones were removed with minimal risk of injuring adjacent important tissues, furthermore, complete debridement of the abscess and precise drainage tube indwelling was achieved simultaneously. Postoperative comprehensive therapy including anti-infection and nutrition support guaranteed a smooth transition of perioperative period. Conclusion This is the first report on application of video-mediastinoscopy in removing two fish bones that migrated extraluminally and debridement of the abscess caused by Esophagus Perforation with minimal injury risk, which offer a safe and effective minimal invasive method for specific cases