FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W4244277178> ?p ?o ?g. }

• W4244277178 endingPage "731" @default.
• W4244277178 startingPage "730" @default.
• W4244277178 abstract "Esophageal perforation due to a traumatic intubation is exceedingly rare. If not noticed immediately or treated promptly, however, the morbidity and mortality is significant. Most cases present within 24 h after the event. A delay in symptoms that signal esophageal perforation after a traumatic endotracheal intubation has serious clinical implications. We report a case of traumatic esophageal perforation due to endotracheal intubation for elective sinus surgery under general anesthesia with a delay in onset of symptoms and signs. The diagnosis and management of this complication are discussed. Case Report A 63-yr-old woman who was otherwise healthy had been suffering from bilateral nasal polyposis that required functional endoscopic sinus surgery. She had a short neck but appeared otherwise unremarkable in the preoperative assessment. During the induction of anesthesia, endotracheal intubation was achieved with difficulty after several attempts because the larynx was behind an overhanging epiglottis. The operation was completed uneventfully. On the first post-operative day, except for deep throat pain, she was stable and could tolerate an oral diet. However, on the following evening (48 h after surgery), she had a persistent sore throat, nausea, and vomiting. Thereafter, she complained of increasing shortness of breath and generalized neck swelling. Physical examination of the neck demonstrated crepitus on palpation. A neck radiograph showed cervical subcutaneous emphysema (Figure 1) and retropharyngeal gas. A chest radiograph did not demonstrate pneumomediastinum. A clinical diagnosis of esophageal perforation was made. The patient then received nasogastric tube feeding and prophylactic IV injections of cefuroxime and metronidazole. A contrast swallow was performed on the next day, and no leakage was demonstrated. Her neck swelling improved and totally subsided by the third postoperative day. She was then gradually allowed to resume an oral diet and was discharged on the 10th postoperative day.Figure 1: Lateral neck radiograph of the patient showing subcutaneous emphysema and retropharyngeal gas (arrows).Discussion Traumatic upper esophageal perforation due to endotracheal intubation is rare and is invariably a result of a difficult endotracheal intubation. Clinically, these cases typically present within 24 h after the operation, and the mortality rate is <or=to56% if the diagnosis is delayed >12 h after the event [1]. A delayed onset of symptoms from esophageal perforation related to traumatic endotracheal intubation is rare and has not been reported in the literature. Our patient complained only of a sore throat and neck pain on the first postoperative day. However, her symptoms worsened over the next day, with nausea and vomiting followed by generalized subcutaneous cervical emphysema and dyspnea. The neck radiograph showed retropharyngeal gas. The cause was determined to be accidental upper cervical esophageal perforation during endotracheal intubation because there was no injury in the pharyngolarynx noted during flexible endoscopy. Although a contrast swallow did not detect any leakage, the postulated sequence of the events would be cervical esophageal laceration caused by intubation injury and leakage of air after vomiting. The cricopharyngeal region is particularly at risk of instrumental injury because the posterior esophageal mucosa at Lannier's triangle is only covered by fascia [2-4]. Early diagnosis and treatment of pharyngoesophageal perforation is important because the retropharyngeal space can communicate freely with the mediastinum. Subcutaneous cervical emphysema, neck pain, and dysphagia are hallmarks of upper esophageal perforation and should raise suspicion if they are present. Diagnosis is suggested if subcutaneous emphysema is seen in the frontal and lateral views of the neck radiograph with a widening mediastinum, pneumomediastinum, or loss of contour of the descending aorta at the level of the left diaphragm showing on the chest radiograph [5]. A water-soluble contrast swallow can confirm the presence and the site of the perforation, as shown by the extravasation of the contrast from the leaking area, but sometimes a leak may not be visible when it is small or when it is healed, as in our case. Esophagoscopy is usually not helpful because it may not show the tear [6]. Computed tomography is more sensitive in making the diagnosis by demonstrating accurately the intramural and extraluminal manifestations of esophageal perforation, such as esophageal wall thickening, periesophageal fluid collection, extraesophageal air, and pleural effusion [7,8]. Treatment for esophageal perforation in the past was mainly by surgical repair. However, an article did report the possibility of managing selected patients conservatively with IV antibiotics, nasogastric tube feeding, or total parenteral nutrition without mortality [9]. In our case, the treatment was conservative because our patient's general condition was stable, she had a normal chest radiograph, and no leakage was demonstrated by the contrast swallow. The risk factors for iatrogenic esophageal perforation during endotracheal intubation include anatomical problems such as broad or short neck, micrognathia, trimus, macroglossia, poor dental health, or cervical spondylosis, which make visualization of the larynx either inadequate or impossible. Using an intubation stylet increases the chance of esophageal perforation. Therefore, both surgeons and anesthetists must be fully aware of the possible delay in onset of symptoms in this potentially fatal condition. Under these circumstances, patients should be closely monitored and kept longer in hospital without oral feeding. This is noteworthy because day surgery is becoming increasingly popular and patients are discharged from the hospital on the day of surgery." @default.
• W4244277178 created "2022-05-12" @default.
• W4244277178 creator A5029853766 @default.
• W4244277178 creator A5033220251 @default.
• W4244277178 creator A5041544662 @default.
• W4244277178 creator A5055276417 @default.
• W4244277178 creator A5090203647 @default.
• W4244277178 date "1998-09-01" @default.
• W4244277178 modified "2023-10-18" @default.
• W4244277178 title "Traumatic Esophageal Perforation Resulting from Endotracheal Intubation" @default.
• W4244277178 cites W1969503142 @default.
• W4244277178 cites W2037272519 @default.
• W4244277178 cites W2067082798 @default.
• W4244277178 cites W2313654226 @default.
• W4244277178 cites W2315483521 @default.
• W4244277178 cites W39566125 @default.
• W4244277178 cites W4250440091 @default.
• W4244277178 doi "https://doi.org/10.1213/00000539-199809000-00047" @default.
• W4244277178 hasPublicationYear "1998" @default.
• W4244277178 type Work @default.
• W4244277178 citedByCount "5" @default.
• W4244277178 countsByYear W42442771782015 @default.
• W4244277178 countsByYear W42442771782017 @default.
• W4244277178 countsByYear W42442771782018 @default.
• W4244277178 crossrefType "journal-article" @default.
• W4244277178 hasAuthorship W4244277178A5029853766 @default.
• W4244277178 hasAuthorship W4244277178A5033220251 @default.
• W4244277178 hasAuthorship W4244277178A5041544662 @default.
• W4244277178 hasAuthorship W4244277178A5055276417 @default.
• W4244277178 hasAuthorship W4244277178A5090203647 @default.
• W4244277178 hasBestOaLocation W42442771781 @default.
• W4244277178 hasConcept C105922876 @default.
• W4244277178 hasConcept C141071460 @default.
• W4244277178 hasConcept C191897082 @default.
• W4244277178 hasConcept C192562407 @default.
• W4244277178 hasConcept C2775970820 @default.
• W4244277178 hasConcept C2777131390 @default.
• W4244277178 hasConcept C2777870961 @default.
• W4244277178 hasConcept C2778456384 @default.
• W4244277178 hasConcept C2778527123 @default.
• W4244277178 hasConcept C2778716859 @default.
• W4244277178 hasConcept C2780842079 @default.
• W4244277178 hasConcept C2780852908 @default.
• W4244277178 hasConcept C42219234 @default.
• W4244277178 hasConcept C71924100 @default.
• W4244277178 hasConcept C81182388 @default.
• W4244277178 hasConceptScore W4244277178C105922876 @default.
• W4244277178 hasConceptScore W4244277178C141071460 @default.
• W4244277178 hasConceptScore W4244277178C191897082 @default.
• W4244277178 hasConceptScore W4244277178C192562407 @default.
• W4244277178 hasConceptScore W4244277178C2775970820 @default.
• W4244277178 hasConceptScore W4244277178C2777131390 @default.
• W4244277178 hasConceptScore W4244277178C2777870961 @default.
• W4244277178 hasConceptScore W4244277178C2778456384 @default.
• W4244277178 hasConceptScore W4244277178C2778527123 @default.
• W4244277178 hasConceptScore W4244277178C2778716859 @default.
• W4244277178 hasConceptScore W4244277178C2780842079 @default.
• W4244277178 hasConceptScore W4244277178C2780852908 @default.
• W4244277178 hasConceptScore W4244277178C42219234 @default.
• W4244277178 hasConceptScore W4244277178C71924100 @default.
• W4244277178 hasConceptScore W4244277178C81182388 @default.
• W4244277178 hasIssue "3" @default.
• W4244277178 hasLocation W42442771781 @default.
• W4244277178 hasLocation W42442771782 @default.
• W4244277178 hasOpenAccess W4244277178 @default.
• W4244277178 hasPrimaryLocation W42442771781 @default.
• W4244277178 hasRelatedWork W2040411404 @default.
• W4244277178 hasRelatedWork W2057094802 @default.
• W4244277178 hasRelatedWork W2058742024 @default.
• W4244277178 hasRelatedWork W2071140542 @default.
• W4244277178 hasRelatedWork W2147257234 @default.
• W4244277178 hasRelatedWork W2434715931 @default.
• W4244277178 hasRelatedWork W2467406589 @default.
• W4244277178 hasRelatedWork W2530017106 @default.
• W4244277178 hasRelatedWork W2597013570 @default.
• W4244277178 hasRelatedWork W2980393352 @default.
• W4244277178 hasVolume "87" @default.
• W4244277178 isParatext "false" @default.
• W4244277178 isRetracted "false" @default.
• W4244277178 workType "article" @default.