Iatrogenic intubation injuries of the upper gastrointestinal tract in adults

Perforation of the hypopharynx, esophagus, and stomach complicated the insertion of flexible tubes in 11 adults. Nasogastric suction tubes were responsible for 5 instances of gastric perforation. Palliative intubation of obstructive carcinomas of the distal esophagus resulted in delayed perforation of the esophagus and stomach in 2 cases. The use of a Linton tube for decompression of bleeding varices caused esophageal rupture in 1 patient whereas 2 others developed pharyngoesophageal perforation due to misplaced endotracheal tubes. The remaining 1 case demonstrated penetration of a chest tube into the esophageal lumen. The radiographic features and mechanisms of these iatrogenic injuries are described and the pertinent literature is reviewed.     

Radiographic evaluation of achalasia immediately after pneumatic dilatation with the Rigiflex dilator

Radiographic evaluation of the lower esophagus was done immediately after pneumatic dilatation using the Rigiflex dilator in 34 patients (24 men, 10 women; mean age, 55 years) with achalasia. The dilator was positioned across the esophagogastic junction using fluoroscopy and the balloon was inflated for 1 min. The esophagus was intubated and injected sequentially with water-soluble and barium contrast materials. Radiographic analysis included changes in the appearance of the caliber and contour of the esophagogastric junction, rate of esophageal emptying, and presence of complications. In 23 patients with predilatation esophagrams, the mean esophagogastric junction caliber increased from 4.7–7.6 mm following dilatation. The postdilatation esophagrams in 33 patients showed a smooth contour in 22 (67%) and immediate esophageal emptying in 26 (79%). Esophageal perforation occurred in one (3%) patient and intramural hematoma in one (3%). Clinical follow-up (mean, 7 months) was available in 29 patients and 23 (79%) had symptomatic improvement. Five of the six patients who did not improve clinically all had previous Heller myotomy, pneumatic dilatation, or both.     

Medication-induced esophagitis

Clinical, radiographic, and endoscopic features of medication-induced esophagitis (MIE) in 4 patients are described. When the clinical history and symptoms raise a high index of suspicion for MIE, a double-contrast esophagram or endoscopic examination should be performed. The proximal esophagus, particularly the aortic segment, and occasionally the distal esophagus are the sites most commonly affected by MIE. Superficial mucosal erosions, shallow ulcers, and subtle mucosal alterations can be demonstrated by double-contrast esophagrams if careful attention is paid during performance and interpretation of these studies in an appropriate clinical setting.     

Radiology of colonic interposition and its associated complications

A retrospective review of the medical records, pathology reports, and radiographic studies of 81 patients who had undergone colonic interposition was undertaken, with special attention to postoperative complications. Both early (within 30 days postoperatively, 81 patients) and late (later than 30 days postoperatively, 57 patients) complications were reviewed. Early findings included anastomotic narrowing (18 patients), anastomotic leak (13), aspiration (11), and ischemic necrosis of the colon (3). Late findings included aspiration (9 patients), anastomotic strictures (8), gastric stasis (6), redundancy and tortuosity of the colon (5), anastomotic ulcers (4), gastrocolic reflux (3), and gastroesophageal reflux into the residual esophagus (2).     

Lymphatic metastases to the esophagus

The authors present 4 cases of esophageal involvement by lymphatic spread of tumors originating in the stomach, distal esophagus, and thyroid. Double-contrast radiographs of the esophagus showed discontinuous submucosal extension and multiple polypoid masses.     

Granular cell tumors of the esophagus

Three cases of granular cell tumor of the esophagus are added to the 17 previously reported in the literature. These tumors, thought to be of neural origin, are difficult to diagnose preoperatively. The diagnosis should be considered in adult females presenting with an intramural mass of the proximal or distal third of the esophagus. Symptoms of dysphagia and substernal discomfort are likely to occur with lesions greater than one centimeter in diameter. Preoperative biopsy is not advised as a mistaken diagnosis of squamous cell carcinoma can result.     

Radiation therapy of esophageal carcinoma: Correlation of clinical and radiographic findings

Seventeen patients with esophageal carcinoma treated by radiation therapy (RT) at our hospital between 1981 and 1984 had initial diagnostic esophagrams and 1 or more repeat esophagrams after completing RT. Total regression of the tumor was observed radiographically in 10 patients (59%) with a normal esophagus (24%) or benign-appearing residual stricture (35%) at the site of the previous lesion. Partial regression was observed in 4 patients, and progression of the tumor in 3. No correlation was found between the size, stage, or morphology of the lesion and its response to therapy. Although local recurrences were relatively uncommon, patient survival was often limited by the development of distant metastases. Fourteen of 15 patients with clinical followup initially had significant relief from dysphagia as the tumor regressed. However, 9 of those patients had recurrent or increased dysphagia over a subsequent 3–9-month period. Exacerbation of symptoms did not necessarily indicate recurrent carcinoma; it also resulted from benign radiation strictures, opportunistic esophagitis, or other complications of RT detected on esophagography.     

Infiltrating carcinoma simulating achalasia

Three cases of carcinoma infiltrating the esophagus and simulating achalasia are presented and the differential diagnostic problems discussed. The radiologic distinction between achalasia and carcinoma can be extremely difficult. Any rigidity, irregularity, nodularity, or ulceration of the distal-most esophagus or gastric fundus or symptoms of short duration in older patients should alert the radiologist to the possibility of carcinoma. It is suggested that all patients with suspected achalasia undergo esophageal and gastric endoscopy with biopsy and esophageal manometry to confirm the diagnosis, expecially if pneumatic dilatation is contemplated.     

Radiologic demonstration of multiple foci of malignancy in the esophagus

Three patients, each with two synchronous esophageal carcinomas demonstrated radiologically, are presented. The importance of complete esophageal evaluation in patients with one obvious tumor of the esophagus is emphasized. Assessment of the full extent of disease in such cases directly affects treatment planning.     

Circumferential web of the upper esophagus

Two patients with circumferential webs of the upper esophagus are presented. Both patients had a long history of intermittent dysphagia, particularly with solid food. The clinical, endoscopic, and radiologic features of these webs are discussed.     

Pharyngoesophageal interrelationships: Observations and working concepts

Simultaneous disorders of the pharynx and esophagus are so frequent that the complete swallowing chain should be examined in all patients with dysphagia. Data are presented to support the concept that such simultaneous disorders represent related phenomena; the mechanism involves changes in cricopharyngeal function seen radiographically as cricopharyngeal prominence. If neurologic disease has been excluded, cricopharyngeal prominence may be the clue to esophageal disease. When cricopharyngeal prominence is found during dynamic imaging of the pharynx, intensive examination of the esophagus and a search for signs of compensation or decompensation in the pharynx should be undertaken.     

Localized saccular dilatation of the esophagus: An unusual cause of dysphagia

Two young women who had undergone resection of an esophageal enteric cyst subsequently developed saccular dilatation of the esophagus. The abnormality was localized to the site of previous surgery and caused dysphagia in both patients.     

Barrett's esophagus complicating scleroderma

Two patients with scleroderma whose esophageal involvement was associated with longstanding reflux esophagitis were found to also have Barrett's esophagus. Since Barrett's esophagus is a premalignant condition, these patients with scleroderma should be considered at high risk for the development of adenocarcinoma of the esophagus.     

Tuberculous fistulas of the pharynx and esophagus

Four patients with tuberculous fistulas communicating with the pharynx or the esophagus are reported. In 1 patient, there was strong evidence to suggest primary involvement of the esophageal mucosa. The other 3 cases were related to involvement of the pharynx or the esophagus from adjacent tuberculous process, as confirmed by histopathological proof.The patients had varying degrees of symptoms, which in two dramatically responded to antituberculous therapy; the third patient needed surgery for complete cure and the last patient was lost to follow-up.     

Hirsute esophagus: Clinical and roentgen features

Clinical and roentgen features of hirsute esophagus in 3 patients are described. Exuberant hair growth and masses of hair in the endopharyngoesophagus produced the classic clinical triad of progressive dysphagia, hair-spitting, and choking spells. This unique and rare complication of reconstructive surgery of the pharynx and esophagus is related to the skin flaps which are mobilized and rotated to reconstruct a skin tube endopharyngoesophagus and to restore anatomical continuity of the gastrointestinal tract.     

Radiographic microstructures of early esophageal carcinoma: Correlation of specimen radiography with pathologic findings and clinical radiography

To clarify the exact radiologic features of mucosal carcinoma of the esophagus with a favorable prognosis, contact radiography was performed on 8 surgical specimens diagnosed preoperatively as showing early or superficial carcinoma. Mucosal carcinoma appeared as a well-defined smooth or nodular protrusion or as a feathered flat mucosa with tiny nodulations and barium poolings. Submucosal carcinoma showed a mound-like defect. The size of tumor was not a good index for estimating the depth of invasion. Protruded lesions were easily demonstrated on clinical radiographs and their profile was useful in determining the depth of invasion. Flat lesions were not easy to recognize; attention must therefore be paid not only to mucosal patterns but also to the contour of the esophageal wall.     

Aphthoid esophageal ulcers in Crohn's disease of ileum and colon

We report 4 cases of tiny aphthous ulcers of the esophagus occurring in patients with confirmed Crohn's disease of the terminal ileum and the colon. These ulcers presented as small collections of barium surrounded by a radiolucent halo, and were demonstrable on double-contrast radiographs of the esophagus. They were located in the middle and distal thirds of the otherwise normal esophagus. A more advanced stage of Crohn's ileocolitis was present in these patients.     

护理干预在食管癌伴糖尿病患者围手术期的作用

目的探讨护理干预在食管癌伴糖尿病患者围手术期中的作用.方法将2000年1月～2005年8月30例合并糖尿病的食管癌患者作为实验组,1990年1月～1999年12月26例合并糖尿病的食管癌患者作为对照组,比较2组血糖控制情况、术后并发症和住院时间.结果实验组患者术前、术后血糖得到良好控制,术后并发症有下降趋势,住院时间缩短.结论护理干预有利于患者血糖的控制,降低术后并发症的发生率,降低手术风险,促进患者早日康复.     

“Discphagia”: A case report

An anterior herniated intervertebral disc at the low cervical level caused dysphagia and an extrinsic impression on the esophagus seen on barium swallow. This entity should be added to the differential diagnosis of extrinsic esophageal defects.     

结扎颈段腹段食管治疗食管破裂10例护理研究

目的:探讨结扎颈段、腹段食管治疗食管破裂患者术后护理。方法:对10例食管结扎患者进行生命体征监测、呼吸道及各种引流管护理,肠内营养支持及心理护理和健康教育。结果:10例患者术后全部治愈,无护理并发症发生。结论:术后除严密观察病情,做好呼吸道及引流管护理外,加强营养和心理支持是预防并发症、提高手术成功率的关键。