Novosti
Khirurgii

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Year 2015 Vol. 23 No 4

CASE REPORTS

B.N. KOTIV1, I.I. DZIDZAVA1, A.O. BREDNEV1, E.E. FUFAEV1, V.L. BELEVICH1, V.I. EGOROV2, I.V. DEYNEGA2

MINIMALLY INVASIVE METHODS IN TREATMENT OF SPONTANEOUS ESOPHAGEAL RUPTURE

FSBMEE HPE "Military Medical Academy named after S.M. Kirov" of the Ministry of Defense of the Russian Federation 1,
FBME "Pokrovskaya City Hospital "2,
Saint-Petersburg,
The Russian Federation

Objectives. To demonstrate the possibilities of minimally invasive surgical approach in the treatment of esophageal rupture – Boerhaave syndrome.
A clinical case of a patient treatment (48 yrs old) with spontaneous rupture of the esophagus, bilateral esophageal-pleural fistula, bilateral pleural empyema. The patient admitted to the hospital in 2 weeks of disease onset. At the early stages of the treatment the closure of the esophagus was not performed. The patient’s condition was heavy due to respiratory failure, and characterized by hemodynamic instability and endogenous intoxication.
In Fibroesophagogastroduodenoscopy two linear ruptures in the lower third of the esophagus were identified: the 1st rupture (a length 25 mm) – on the left lateral esophageal wall, the 2nd – on the right wall (a length ≈5 mm).
In an X-ray contrast study of the esophagus and spiral computed tomography of the chest a rupture of the lower third of the esophagus with the transport of the contrast medium in both pleural cavities and the left-sided hydropneumothorax have been observed. Due to the continuing significant contributions of discharge with an admixture of gastric contents along the pleural drains the stenting of lower third of esophagus by self-expanding nitinol – coated stents has been performed.
Analysis of the radiography dynamics showed no leakage of contrast medium. A week later a distal shift of the stent was observed so that the stent was extracted. According to the results of the control endoscopy the mucosal defect on the right wall of the esophagus was healed, on the left wall – the size of fistula reduced to 12 mm. To reduce the diameter of the rupture and reflux of the esophageal-gastric contents into the left pleural cavity, the endoclips were applied on the edge of the mucosa in the area of defect. On the 26th days after clipping an esophago-pleural fistula was completely obliterated and the mucosal rupture epithelizied. The drainage from the left pleural cavity was removed; the patient was discharged in a satisfactory condition.

Keywords: esophageal diseases, surgery, esophageal perforation, esophagoscopy, mortality, mediastinal diseases, spontaneous rupture
p. 467-473 of the original issue
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Address for correspondence:
194044, Russian Federation,
g. Sankt-Peterburg, ul. Akademika Lebedeva, d. 6,
FGBVOU VPO "Voenno-meditsinskaya akademiya im. S.M. Kirova" MO RF,
kafedra gospitalnoy khirurgii,
tel. 8-911-969-28-06,
e-mail: antonbrednev@rambler.ru,
Brednev Anton Olegovich
Information about the authors:
Kotiv B.N. MD, professor, a Deputy chief for educational and scientific work of FSBMEE "Military Medical Academy named after S.M.Kirov", the Ministry of Defense of the Russian Federation, Major General of medical service.
Dzidzava I.I. MD, a head of the hospital surgery chair of FSBMEE "Military Medical Academy named after S.M.Kirov", the Ministry of Defense of the Russian Federation, Colonel of medical service.
Brednev A.O. An adjunct of the hospital surgery chair of FSBMEE "Military Medical Academy named after S.M.Kirov", the Ministry of Defense of the Russian Federation, Captain of medical service.
Fufaev E.E. PhD, an applicant for Doctor’s degree of the hospital surgery chair of FSBMEE "Military Medical Academy named after S.M. Kirov", the Ministry of Defense of the Russian Federation, Lieutenant colonel of medical service.
Belevich V.L. PhD, a senior lecturer of the hospital surgery chair of FSBMEE "Military Medical Academy named after S.M. Kirov", the Ministry of Defense of the Russian Federation, Colonel of medical service.
Egorov V.I. PhD, a head of the thoracic department of SBME "Pokrovskaya City Hospital".
Deynega I.V. A physician of the thoracic department of SBME "Pokrovskaya City Hospital".
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