Clinical Challenges in Thoracic Surgery: Esophageal Perforation

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 28 March 2022

⏱️ 41 minutes

🔗️ Recording | iTunes | RSS

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Summary

Thoughts of esophageal perforations keeping you up at night? Actual esophageal perforations keeping you up at night? Drs. Brian Louie, Peter White, and Megan Lenihan discuss both the tried-and-true and the cutting-edge management of this challenging problem.

Learning Objectives

- Understand basic principles of management

- Review differences in management based on different underlying pathology and location

- Learn indications and techniques for advanced endoscopic interventions for perforations

- Discuss nutrition planning

Referenced Material

- Thornblade LW, Cheng AM, Wood DE et al. A Nationwide Rise in the Use of Stents for Benign Esophageal Perforation. Ann Thorac Surg 2017; 104(1):227-233. DOI: 10.1016/j.athoracsur.2017.03.069
http://dx.doi.org/10.1016/j.athoracsur.2017.03.069

- Watkins JR and Farivar AS. Endoluminal Therapies for Esophageal Perforations and Leaks. Thorac Surg Clin 2018; 28(4):541-554. DOI: 10.1016/j.thorsurg.2018.07.002
https://doi.org/10.1016/j.thorsurg.2018.07.002

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Transcript

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0:00.0	Behind the Night, the Surgery Podcast, relevant and engaging content designed to help you dominate the day.
0:13.0	Welcome back to Behind the Night with your thoracic surgery team from Swedish Medical Center in Seattle.
0:28.0	I'm Megan Lennahan, and I'm joined by the esteemed Dr. Brian Lilly.
0:33.0	Hello.
0:34.0	And Peter White.
0:36.0	Hi.
0:37.0	On this episode, we're going to discuss esophageal perforations as part of the Clinical Challenges in Surgery series.
0:44.0	Since you're just listening, I'm going to paint your picture of what's going on in the recording room right now.
0:48.0	Dr. Lilly is grinning like a maniac. I've never seen this man so excited.
0:53.0	I'm sure everyone listening shares his enthusiasm for the goose.
0:58.0	I do love this. This is a huge topic.
1:01.0	And we won't be able to cover everything, but we'll try to get through most of the topics.
1:06.0	Our goals are to go through the management of the most common pathologies you are likely to encounter,
1:11.0	and then talk more briefly about some of the nuanced scenarios and finally cover a dosk be a nutrition.
1:16.0	Let's get started with our first case, Megan.
1:19.0	This is a 61-year-old man, no-no-medical history other than heavy alcohol use and a recent binge.
1:27.0	The night of presentation, he had been wretching and began complaining of severe chest pain and epicastric pain.
1:33.0	So he came into the ED.
1:34.0	He was diaphrenic and grunting with respirations, obviously in pain, a bit altered.
1:40.0	And his lab work showed a lactate of six, white kind of 19, and cratine at 1.6.
1:45.0	So clearly he's sick. They got a chest X-ray that showed pneumometheus dinam and a left lung-based infiltrate with chloral effusion.
1:55.0	And CT of the chest abdomen pelvis showed a high edal hernia, extensive pneumometheus dinam, and a moderate left chloral effusion.
	...

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