Project description:Boerhaave syndrome is the spontaneous rupture of the oesophagus, usually due to vomiting. The condition is rare but can be fatal. A 30-year-old male presented with vomiting and pain in his left flank and chest. Computed tomography scanning of the chest, abdomen and pelvic revealed a 4 mm left proximal ureteric stone and pneumo-mediastinum due to oesophageal rupture, consistent with Boerhaave syndrome. The patient underwent insertion of left ureteric stent, with staged left ureteroscopy and laser lithotripsy. The patient's oesophageal rupture was managed conservatively, and he made a full recovery. This is only the second report of renal colic causing Boerhaave syndrome.
Project description:Boerhaave syndrome refers to a spontaneous perforation of the esophagus that results from severe straining or vomiting. This uncommon situation may lead to serious outcome with chemical mediastinitis, and is associated with high morbidity and mortality. Surgery, although associated with high morbidity and mortality remains the treatment of choice, whereas endoscopic management with stent placement is preserved to treat inoperable patients. Removal of the stent is generally recommended after 4-6 weeks. We report a case of an elderly patient who presented with a large complicated Boerhaave's mid-esophageal perforation, with a complete recovery after a 3-month treatment with a long esophageal stent.
Project description:Background and aimsThere is growing interest in closure of larger mucosal defects, given the increasing use of endoscopic resection for early GI neoplasia and the advent of submucosal endoscopy, including peroral endoscopic myotomy. Existing closure methods include through-the-scope clips, over-the-scope clips, and over-the-scope suturing. Although over-the-scope clips and over-the-scope suturing allow closure of large defects, both require endoscope removal for device application and may have difficulty in treating lesions in the proximal colon or the small intestine. Hence, a significant gap exists for a through-the-scope device capable of closing larger defects. The novel X-Tack system (Apollo Endosurgery, Austin, Tex, USA) offers through-the-scope suturing (TTSS), which eliminates the need to withdraw the endoscope from the patient before applying therapy.MethodsWe demonstrate the possible indications for endoscopic mucosal adhesion with TTSS through a video case series. We present 5 cases to illustrate the use of TTSS in the closure of a duodenal EMR defect, a cecal EMR defect, mucostomy after esophageal and gastric peroral endoscopic myotomy, and, finally, for primary closure of a gastrogastric fistula.ResultsAll defects were successfully closed with 1 to 2 TTSS systems. There were no postprocedure adverse events, including bleeding or perforation, at a median of 30 (range 14-30) days of follow-up.ConclusionsTTSS is a valuable addition to mucosal closure devices, which allows closure through a gastroscope or a colonoscope, without requiring endoscope removal for device application. Likely applications include larger or more distant defects and those located within tight spaces. Pending further clinical evaluation, important areas for research include assessment of the learning curve, comparative trials with other closure devices, and cost-effectiveness analysis.
Project description:Multiple reports have demonstrated the efficacy of endoscopic dacryocystorhinostomy (DCR). However the results of the same have varied from centre to centre. Many still regard external DCR as the gold standard. To describe an endoscopic DCR technique which anatomically simulates an external DCR and assess its results. Prospective, nonrandomized and noncomparative interventional case series. Clinical charts of patients with nasolacrimal duct obstruction based on symptomatic, clinical and radiological basis were included in the study. All surgeries were done endonasally using standard operative technique. The modification in the standard technique included creating a wide exposure of the lacrimal sac, incising the sac and the suturing the medial wall of the lacrimal sac with the lateral nasal wall. The same was achieved by using either vascular clips or 5.0 vicryl sutures. Twenty (11 females and 9 males) were included in the study. The average age of the patients was 56.86 years old (range 27-85 years old). The main presenting symptom was epiphora and 1 patient with mucocele. Successful outcome was measured in terms of relief of sympto anatomical patency assessed by sac syringing and nasal endoscopy showing a wide patent lumen. A primary success rate of 95% and ultimate rate of 100% was achieved in the cases with a nasolacrimal duct (NLD) block while an overall success rate of 82.6% was noted when the cases with NLD block and common canalicular block were considered together. Endoscopic DCR can now easily replace external DCR as a standard. It is not only minimally invasive, but has minimal complications and using this technique, we have been able to achieve very high success rates.
Project description:Video 1Successful endoscopic management of a large esophageal defect due to Boerhaave syndrome with endoscopic vacuum therapy using EsoSponge and VACStent.
Project description:BackgroundA rare complication of oesophageal rupture or Boerhaave syndrome is myopericarditis due to leakage of oesophageal contents. This presentation can mimic a myocardial infarction, making diagnosis and management challenging.Case summaryWe present the case of a middle-aged man presenting with chest pain, who was diagnosed with Boerhaave syndrome complicated by myopericarditis, although the presentation was concerning for acute coronary syndrome.DiscussionThrough this case, we aim to highlight an unusual alternative aetiology of findings classically seen in myocardial infarction.