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The offices of pediatric gastroenterologists are filled with infants whose pediatricians have diagnosed gastroesophageal reflux disease. Infants with arching, crying, spitting, and food refusal are being diagnosed with GERD. Although [...]

Study objectives: To analyze the accuracy of esophageal endoscopic ultrasound (EUS) with real-time, guided fine-needle aspiration (EUS-FNA) with an on-site cytopathologist in patients with (presumed) lung cancer presenting with mediastinal [...]

Study objectives: Atrioesophageal fistulas have been reported to be a lethal complication following catheter ablation of atrial fibrillation (AF). The purpose of this study was to investigate the relationship between [...]

We present a case report of Boerhaave syndrome or spontaneous post-emetic rupture of the esophagus complicated with an esophagopleural fistula of which the diagnosis was missed at the initial presentation in the emergency. Surgical intervention was delayed for more than two weeks until the esophageal perforation was recognized. The patient was optimized for surgery and a single-stage esophageal bypass surgery was done where the esophagus was left in situ, the stomach was pulled up through the substernal route and a cervical esophagogastric anastomosis was made to restore the gastrointestinal continuity; thus avoiding the morbidity associated with an esophagostomy and a second procedure for delayed reconstruction. Keywords: Boerhaave syndrome | esophagopleural fistula, Introduction Boerhaave's syndrome or post-emetic rupture of the esophagus described by Hermann Boerhaave in 1724 (1) is a rare but serious entity that is difficult to diagnose because often no [...]

Boerhaave's syndrome a rare condition, not only poses a diagnostic and management dilemma1, but also has a high morbidity and mortality. In remote Northern territory, we saw three cases in three weeks in March 2009. These patients underwent surgery in our hospital .We present our series of three cases, our management and lessons we learnt., Introduction Boerhaave's syndrome a rare condition, not only poses a diagnostic and management dilemma (1), but also has a high morbidity and mortality. In remote Northern territory, we saw three [...]

Objectives: To show the importance of considering a mechanical and potentially treatable cause, such as a paraoesophageal hernia, in the differential diagnosis of stridor. Such cases can be referred to the upper GI multi-disciplinary team meeting for appropriate surgical input. Case report: We report the case of a 79-year-old man with Parkinson's disease presenting with intermittent stridor secondary to oesophageal dilatation from a paraoesophageal hernia. A computerised tomography (CT) scan of his thorax provided the diagnosis. The patient was referred to the upper GI multi-disciplinary team meeting and underwent a laparoscopic reduction and repair of the paraoesophageal hernia that resolved his symptoms. Conclusion: A paraoesophageal hernia can be a rare cause of stridor. Since surgical treatment is now available, we suggest that a referral to the upper GI multi-disciplinary team is important once prompt diagnosis has been made. Keywords: stridor | mega-oesophagus | paraoesophageal hernia, Introduction Stridor secondary to oesophageal disease is rare but has been reported previously (1-6). Oesophageal dilatation leading to tracheal compression may be due to mechanical, neurological or idiopathic motility causes. [...]

We present a case report of Boerhaave syndrome or spontaneous post emetic rupture of esophagus complicated with esophagopleural fistula whose diagnosis was missed at the initial presentation in the emergency. Surgical intervention was delayed for more than two weeks until the esophageal perforation was recognized. The patient was optimized for surgery and a single stage esophageal bypass surgery was done where the esophagus was left in situ and the stomach was pulled up through the sub sternal route and a cervical esophagogastric anastomosis was made to restore the gastrointestinal continuity; thus avoiding the morbidity associated with an esophagostomy and a second procedure for delayed reconstruction. Keywords: Boerhaave syndrome | esophagopleural fistula, Introduction Boerhaave's syndrome or post emetic rupture of esophagus described by Hermann Boerhaave in 1724 (1) is a rare but serious entity that is difficult to diagnose because often no [...]

Effective hemostatic treatment is very important for patients with actively bleeding Mallory-Weiss syndrome. Various non-surgical and surgical interventions have been used to treat upper gastrointestinal bleeding secondary to Mallor-Weiss tears. In this report, we aimed to present three actively bleeding Mallory-Weiss cases. Sclerotherapy with epinephrine injection succesfully stopped the bleeding in the first two patients and emergent surgery had to be performed in the third case due to hemodynamic instability. The severity of the bleeding, the technical equipment and the experience of the medical team are important in the treatment of Mallory-Weiss syndrome. Keywords: Mallory-Weiss Syndrome | sclerotherapy | surgery, Introduction Mallory-Weiss syndrome (MWS) is a common cause of non-variceal upper gastrointestinal bleeding with an incidence of 5-15% (1). Although hemodynamic support is the preferred treatment modality in most cases [...]

Nutcracker esophagus (NE) is a manometric pattern that is commonly seen in patients with noncardiac chest pain and/or dysphagia with normal esophageal peristalsis. We report a rare association of multiple epiphrenic esophageal diverticulae of distal esophagus with NE. Keywords: Nutcracker esophagus | epiphrenic esophageal diverticulae, Introduction Primary esophageal motility disorders comprise various abnormal manometric patterns which usually present with dysphagia or chest pain. Unlike achalasia other disorders like diffuse esophageal spasm (DES) and NE , [...]

We describe a case of spontaneous esophageal perforation (Boerhaave's syndrome) that was admitted at our department with acute clinical symptoms: dyspnea, thoracic pain and vomit after episode of alcohol abuse. Pneumothorax was suspected: early chest X-rays revealed left sided pleural effusion with complete collapse of the omolateral lung and pneumomediastinum. Successive esophagoscopy showed a 1-cm longitudinal perforation on the left side of the lower esophagus. Perforation was repaired by direct suture and reinforced with endoprosthesis. Patient was discharged on the 45th postoperative day without complications occurred after 1-year period. Keywords: Esophageal perforation | Mediastinitis | Surgical treatment | Primary repair | Pneumothorax, Introduction Spontaneous esophageal perforations are still potentially life-threatening associated with considerable mortality and morbidity. Surgical primary closure, with or without associated procedure of reinforce, represents the standard treatment option in [...]

We describe a case of spontaneous esophageal perforation (Boerhaave's syndrome) that was admitted at our department with acute clinical symptoms: dyspnea, thoracic pain and vomit after episode of alcohol abuse. Pneumothorax was suspected: early chest X-rays revealed left sided pleural effusion with complete collapse of the omolateral lung and pneumomediastinum. Successive esophagoscopy showed a 1-cm longitudinal perforation on the left side of the lower esophagus. Perforation was repaired by direct suture and reinforced with endoprosthesis. Patient was discharged on the 45th postoperative day without complications occurred after 1-year period. Keywords: Esophageal perforation; Mediastinitis; Surgical treatment; Primary repair; Pneumothorax, Table of Contents Abstract Introduction Clinical Summary Comment References Introduction Spontaneous esophageal perforations are still potentially life-threatening associated with considerable mortality and morbidity. Surgical primary closure, with or without associated [...]

Nutcracker esophagus (NE) is a manometric pattern that is commonly seen in patients with noncardiac chest pain and/or dysphagia with normal esophageal peristalsis. We report a rare association of multiple epiphrenic esophageal diverticulae of distal esophagus with NE. Keywords: Nutcracker esophagus, epiphrenic esophageal diverticulae, Table of Contents Abstract Introduction Case Report Discussion References Introduction Primary esophageal motility disorders comprise various abnormal manometric patterns which usually present with dysphagia or chest pain. Unlike achalasia other [...]

Objective: To assess the role of x-ray soft tissue neck lateral view in patients presenting with cervical esophageal foreign bodies. Materials and Methods: A prospective study, in patients with suspected foreign bodies in the esophagus, was conducted in ENT department, TUTH, April 2004 to July 2008. All patients underwent x-ray soft tissue neck lateral view at the time of presentation. Findings of hypopharyngoscopy/ upper esophagoscopy were analysed using Chi Square ([chi square]) and different signs were compared by Z test of proportion. Results: Out of 230 patients, 51.3% were children. There were 84.4% patients with positive finding on x- ray. Soft signs were seen in 16.1% while foreign body was visualized in 53.9% patients. Foreign body along with soft sign was visualized in 14.3% patients. Conclusion: Overall sensitivity of x-ray soft tissue neck was 84.4% in diagnosing foreign body esophagus. Plain x-ray soft tissue neck lateral view is a cheap, easy and non invasive investigation to identify foreign body esophagus. Keywords: Foreign Bodies, x-ray soft tissue neck, esophagus, soft signs, Table of Contents Abstract Introduction Materials and Methods Results Discussion Conclusion References Introduction Foreign body ingestion is a common problem in both children and adults. (1,2,3,4) It carries significant morbidity [...]

Objective: To report a rare case of impacted foreign body (artificial denture) in the oesophagus and review the literature. Case Report: This is a case report of impacted foreign body (artificial denture) in the oesophagus. The wire could be seen on x-ray soft tissue neck lateral view. But rigid oesphagoscopy could not remove the denture and the patient developed cervical emphysema in the first post operative period. Foreign body (artificial denture) was removed by Oesophagotomy and retrieval of denture and sternocleidomastoid muscle patching via external approach. Conclusion: Foreign body ingestion is a common problem. Early removal of foreign bodies must be considered to reduce the risk of complications. Impacted denture in the oesophagus which was removed by oesophagotomy is an unusual presentation. To the best of our knowledge this is the first case report from Nepal. Keywords: Foreign body (artificial denture), oesophagus, rigid oesophagoscopy, oesophagotomy, Table of Contents Abstract Introduction Case Report Discussion Conclusion References Introduction Foreign body ingestion is a common problem (1). Most common foreign bodies in pediatric age group are coins (2,3) [...]

Table of Contents Abstract Discussion References Abstract Endotracheal intubations and nasogastric tube (NG) insertions are common procedures in any neonatal intensive care unit. But complications secondary to these procedures are [...]

Table of Contents Abstract Introduction Case Report Discussion References Abstract Tuberculosis is one of the common infectious diseases in developing country, commonly affecting the gastrointestinal tract. Esophageal tuberculosis is rare [...]

A 48 year old woman was brought by ambulance to the department with a history of shortness of breath of five days duration. Examination revealed a normotensive, tachypneic, tachycardic, afebrile [...]

Gastroesophageal reflux disease (GERD) is a common chronic disease in the older population. Because of the cumulative effects of acid reflux over many years, older patients with GERD are at [...]

Speech-language pathologists in medical settings have long tried to quantify the degree of clinical pharyngeal impairment they see, and even experts often fail to agree on the major source of [...]