Perfurações esofágicas
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Data
2007-06-01
Autores
Henry, Maria Aparecida Coelho de Arruda [UNESP]
Lerco, Mauro Masson [UNESP]
Oliveira, Walmar Kerche de [UNESP]
Cataneo, Antonio José Maria [UNESP]
Cataneo, Daniele Cristina [UNESP]
Ruiz Júnior, Raul Lopes [UNESP]
Pereira, Rodrigo Severo de Camargo [UNESP]
Título da Revista
ISSN da Revista
Título de Volume
Editor
Colégio Brasileiro de Cirurgia Digestiva
Resumo
RACIONAL: Dentre as perfurações do trato gastrointestinal, as lesões do esôfago são as de pior prognóstico. OBJETIVO: Avaliar os aspectos etiológicos, diagnósticos e terapêuticos de pacientes com perfuração esofágica atendidos no Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP. MÉTODOS: Avaliação retrospectiva de pacientes internados no período de janeiro de 1999 a dezembro de 2006. Foram estudados 24 pacientes (18 homens e 6 mulheres) com idade média de 52 anos. Os pacientes foram divididos em dois grupos de 12. O Grupo 1 compreendia os pacientes cuja perfuração ocorreu na evolução de câncer do esôfago e o Grupo 2 os pacientes com perfuração devida a causas diversas. No Grupo 2 as causas foram: procedimento endoscópico em três casos, fundoplicatura em três, ingestão de corpo estranho em dois, balão de Blackmore em um, ingestão de antiinflamatório em um, pós-operatório de diverticulectomia em um, ferimento por arma de fogo em um. O esôfago torácico foi o local mais acometido (12 pacientes no Grupo 1 e sete no Grupo 2. em cinco pacientes do Grupo 1 foi realizada entubação transtumoral e nos demais gastrostomia ou jejunostomia. No Grupo 2, o procedimento realizado nas perfurações do esôfago torácico foi esofagectomia. RESULTADOS: A mortalidade operatória no Grupo 1 foi de 25% e no Grupo 2 de 8,33%. Conclusão - a) A lesão do esôfago cervical apresenta, em geral, evolução favorável; b) a conduta cirúrgica, mesmo quando realizado em fase não precoce (primeiras 24 horas), resulta em boa resolução.
BACKGROUND:- Among perforations of the gastrointestinal tract, esophageal lesions are of worst prognosis. AIM: To evaluate the etiology, frequency, diagnosis and therapeutic applied in patients with esophageal perforations assisted at the clinical hospital of the Botucatu School of Medicine - UNESP. METHODS: This is a retrospective assessment of patients hospitalized from January 1999 to December 2006. Twenty-four patients (18 males and 6 females) with a mean age of 52 years were studied. Patients were divided into 2 groups of 12 individuals each: Group 1: patients whose perforation occurred during esophageal cancer development, and Group 2: patients with perforation resulting from various causes. In Group 2, the causes were endoscopic procedure (3), fundoplication (3), foreign body ingestion (2), Blackmore balloon (1), anti-inflammatory drug ingestion (1), diverticulectomy postoperative period (1), firearm wound (1). Thoracic esophagus was the most frequently affected site 12 patients in Group 1 and 7 in Group 2. In 5 patients from Group 1, transtumoral intubation was performed, and gastrostomy or jejunostomy was carried out in the others. In Group 2, the procedure adopted for thoracic perforations was esophagectomy. RESULTS: Operative mortality in Group 1 was 25%, and in Group 2 it was of 8.33%. CONCLUSIONS: a) Cervical esophageal lesion generally presents favorable development; b) surgical treatment, even when performed at a non-early phase (first 24 hours) results in good evolution.
BACKGROUND:- Among perforations of the gastrointestinal tract, esophageal lesions are of worst prognosis. AIM: To evaluate the etiology, frequency, diagnosis and therapeutic applied in patients with esophageal perforations assisted at the clinical hospital of the Botucatu School of Medicine - UNESP. METHODS: This is a retrospective assessment of patients hospitalized from January 1999 to December 2006. Twenty-four patients (18 males and 6 females) with a mean age of 52 years were studied. Patients were divided into 2 groups of 12 individuals each: Group 1: patients whose perforation occurred during esophageal cancer development, and Group 2: patients with perforation resulting from various causes. In Group 2, the causes were endoscopic procedure (3), fundoplication (3), foreign body ingestion (2), Blackmore balloon (1), anti-inflammatory drug ingestion (1), diverticulectomy postoperative period (1), firearm wound (1). Thoracic esophagus was the most frequently affected site 12 patients in Group 1 and 7 in Group 2. In 5 patients from Group 1, transtumoral intubation was performed, and gastrostomy or jejunostomy was carried out in the others. In Group 2, the procedure adopted for thoracic perforations was esophagectomy. RESULTS: Operative mortality in Group 1 was 25%, and in Group 2 it was of 8.33%. CONCLUSIONS: a) Cervical esophageal lesion generally presents favorable development; b) surgical treatment, even when performed at a non-early phase (first 24 hours) results in good evolution.
Descrição
Palavras-chave
Esôfago, Perfuração esofágica, Gastrostomia, Esophagus, Esophageal perforation, Gastrostomy
Como citar
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). Colégio Brasileiro de Cirurgia Digestiva, v. 20, n. 2, p. 73-76, 2007.