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Esophgeal Perforation and Bilateral Empyema Following Endoscopic EsophyX Transoral Incisionless Fundoplication.

Edriss H, El-Bakush A, Nugent K - Clin Endosc (2014)

Bottom Line: He underwent TIF complicated by esophageal perforation and developed mediastinitis, left pneumothorax, bilateral pleural effusions, and acute respiratory failure.He required chest tube placement and bilateral decortication for treatment of nonresolving empyemas.Additional postmarketing studies are required to assess the safety, efficacy, and clinical outcomes of this novel procedure, and patients undergoing this procedure need close postprocedural follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.

ABSTRACT
Transoral incisionless fundoplication (TIF) has been used for endoscopic treatment of gastroesophageal reflux disease (GERD). TIF using the EsophyX device system (EndoGastric Solutions) was designed to create a full-thickness valve at the gastroesophageal junction through the insertion of multiple fasteners; it improves GERD, reduces proton pump inhibitor use, and improves quality of life. Although TIF is effective in select patients, a significant subset of patients undergoing TIF develop persistent or recurrent GERD symptoms and may need antireflux surgery to control the GERD symptoms. We now report a 48-year-old man with chronic GERD unresponsive to medical management. He underwent TIF complicated by esophageal perforation and developed mediastinitis, left pneumothorax, bilateral pleural effusions, and acute respiratory failure. He required chest tube placement and bilateral decortication for treatment of nonresolving empyemas. Additional postmarketing studies are required to assess the safety, efficacy, and clinical outcomes of this novel procedure, and patients undergoing this procedure need close postprocedural follow-up.

No MeSH data available.


Related in: MedlinePlus

Computed tomography of the chest shows bilateral pleural effusions greater on the left side (arrow A), pneumomediastinum (arrow B), and anterior left-sided pneumothorax (arrow C). There are compressed and atelectatic lungs at both lung bases.
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Figure 1: Computed tomography of the chest shows bilateral pleural effusions greater on the left side (arrow A), pneumomediastinum (arrow B), and anterior left-sided pneumothorax (arrow C). There are compressed and atelectatic lungs at both lung bases.

Mentions: Laboratory studies revealed a white blood count of 16.9×109/L, a hemoglobin level of 16 g/dL, a blood urea nitrogen level of 22 mg/dL, a serum creatinine level of 1.2 mg/dL, a serum lactate level of 2.7 mmol/L, a total protein level of 5.7 g/dL, and a lactate dehydrogenase (LDH) level of 170 U/L. Arterial blood gases revealed pH 7.27, PaCO2 46.7 mm Hg, PaO2 53.2 mm Hg, and HCO3 21 mmol/L. Computed tomography of the chest showed moderate-to-large left-sided and moderate right-sided pleural effusions, a left-sided pneumothorax, and pneumomediastinum, findings consistent with distal esophageal perforation (Fig. 1). Computed tomography of the abdomen showed pneumoperitoneum. The patient was started on vancomycin and ertapenem. A left-sided chest tube was inserted, and purulent, brown-greenish fluid was drained (1,300 mL) during the tube placement. Pleural fluid analysis showed an exudative effusion consistent with esophageal perforation and empyema with a white blood cell count of 1.75×109/L (mainly neutrophils), a protein level of 44 g/L, an LDH level of 7,589 U/L, a fluid protein/serum protein ratio of 0.77, a fluid LDH/serum LDH ratio of 4.46, an amylase level of 335 U/L, a lipase level of 1,188 U/L, and a glucose level of 20 mg/dL.


Esophgeal Perforation and Bilateral Empyema Following Endoscopic EsophyX Transoral Incisionless Fundoplication.

Edriss H, El-Bakush A, Nugent K - Clin Endosc (2014)

Computed tomography of the chest shows bilateral pleural effusions greater on the left side (arrow A), pneumomediastinum (arrow B), and anterior left-sided pneumothorax (arrow C). There are compressed and atelectatic lungs at both lung bases.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4260105&req=5

Figure 1: Computed tomography of the chest shows bilateral pleural effusions greater on the left side (arrow A), pneumomediastinum (arrow B), and anterior left-sided pneumothorax (arrow C). There are compressed and atelectatic lungs at both lung bases.
Mentions: Laboratory studies revealed a white blood count of 16.9×109/L, a hemoglobin level of 16 g/dL, a blood urea nitrogen level of 22 mg/dL, a serum creatinine level of 1.2 mg/dL, a serum lactate level of 2.7 mmol/L, a total protein level of 5.7 g/dL, and a lactate dehydrogenase (LDH) level of 170 U/L. Arterial blood gases revealed pH 7.27, PaCO2 46.7 mm Hg, PaO2 53.2 mm Hg, and HCO3 21 mmol/L. Computed tomography of the chest showed moderate-to-large left-sided and moderate right-sided pleural effusions, a left-sided pneumothorax, and pneumomediastinum, findings consistent with distal esophageal perforation (Fig. 1). Computed tomography of the abdomen showed pneumoperitoneum. The patient was started on vancomycin and ertapenem. A left-sided chest tube was inserted, and purulent, brown-greenish fluid was drained (1,300 mL) during the tube placement. Pleural fluid analysis showed an exudative effusion consistent with esophageal perforation and empyema with a white blood cell count of 1.75×109/L (mainly neutrophils), a protein level of 44 g/L, an LDH level of 7,589 U/L, a fluid protein/serum protein ratio of 0.77, a fluid LDH/serum LDH ratio of 4.46, an amylase level of 335 U/L, a lipase level of 1,188 U/L, and a glucose level of 20 mg/dL.

Bottom Line: He underwent TIF complicated by esophageal perforation and developed mediastinitis, left pneumothorax, bilateral pleural effusions, and acute respiratory failure.He required chest tube placement and bilateral decortication for treatment of nonresolving empyemas.Additional postmarketing studies are required to assess the safety, efficacy, and clinical outcomes of this novel procedure, and patients undergoing this procedure need close postprocedural follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.

ABSTRACT
Transoral incisionless fundoplication (TIF) has been used for endoscopic treatment of gastroesophageal reflux disease (GERD). TIF using the EsophyX device system (EndoGastric Solutions) was designed to create a full-thickness valve at the gastroesophageal junction through the insertion of multiple fasteners; it improves GERD, reduces proton pump inhibitor use, and improves quality of life. Although TIF is effective in select patients, a significant subset of patients undergoing TIF develop persistent or recurrent GERD symptoms and may need antireflux surgery to control the GERD symptoms. We now report a 48-year-old man with chronic GERD unresponsive to medical management. He underwent TIF complicated by esophageal perforation and developed mediastinitis, left pneumothorax, bilateral pleural effusions, and acute respiratory failure. He required chest tube placement and bilateral decortication for treatment of nonresolving empyemas. Additional postmarketing studies are required to assess the safety, efficacy, and clinical outcomes of this novel procedure, and patients undergoing this procedure need close postprocedural follow-up.

No MeSH data available.


Related in: MedlinePlus