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Medicine (Baltimore) 2020 May;99(22):e20474

Pediatric Unit, Maternal and Child Department, Azienda USL of Reggio Emilia, Sant'Anna Hospital, Castelnovo ne' Monti, Italy.

Rationale: Triple-A syndrome, or Allgrove syndrome (AS), is a rare autosomal recessive disorder characterized by the alacrimia, achalasia, and adrenal insufficiency triad. Alacrimia usually starts at early infancy, while achalasia and adrenal insufficiency appear later during childhood or adulthood. Some patients may also present with the so-called Double-A syndrome (i. Read More

Am Heart J 2020 03 9;221:19-28. Epub 2019 Dec 9.

Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada. Electronic address:

Background: Although there have been several reports documenting complications related with transesophageal echocardiography (TEE) manipulation following cardiac surgery, there is a paucity of data regarding the safety of TEE used to guide catheter-based interventions. The aim of this study was to determine the prevalence, types and risk factors of complications associated with procedures requiring active TEE guidance.

Methods: This study included 1249 consecutive patients undergoing either transcatheter aortic valve implantation (TAVI), Mitraclip, left atrial appendage occlusion (LAAO) or paravalvular leak closure (PVLC). Read More

World J Gastroenterol 2019 Sep;25(34):5174-5184

Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.

Background: Adverse events during endoscopic submucosal dissection (ESD) of superficial esophageal neoplasms, such as perforation and bleeding, have been well-documented. However, the Mallory-Weiss Tear (MWT) during esophageal ESD remains under investigation.

Aim: To investigate the incidence and risk factors of the MWT during esophageal ESD. Read More

JAAPA 2019 Aug;32(8):1-3

Ryan Olivero practices general and thoracic surgery at St. John Providence Hospital in Novi, Mich. The author has disclosed no potential conflicts of interest, financial or otherwise.

Spontaneous esophageal perforation, also called Boerhaave syndrome, is a relatively rare condition that can result in significant morbidity or mortality. The tear commonly involves all three layers of the esophagus. It results from increased intraluminal pressure, most commonly from violent retching and vomiting. Read More

Gastrointest Endosc 2019 06 26;89(6):1251-1252. Epub 2019 Feb 26.

Division of Gastroenterology and Hepatology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.

Emerg Radiol 2019 Aug 21;26(4):373-379. Epub 2019 Feb 21.

McGovern Medical School, Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin Street, 2.130B, Houston, TX, 77030, USA.

Purpose: To evaluate chest injury patterns in pediatric patients involved in all-terrain vehicle (ATV) accidents.

Methods: Retrospective review of patients 0-18 years old admitted to a level I trauma institute following an ATV-related incident from 2004 to 2013 was performed. Chest injury type, accident mechanism, driver/passenger status, and demographic and clinical data were compared between patients with and without chest injury. Read More

Medicine (Baltimore) 2018 Nov;97(48):e13422

Department of Gastroenterology, The Fifth Affiliated Hospital of Wenzhou Medical University.

Rationale: Most of esophageal rupture is a very serious life-threatening benign gastrointestinal tract disease with high mortality. However, there are a few cases of spontaneous esophageal rupture during gastroscopy.

Patient Concerns: A 57-year-old man who underwent a routine diagnostic gastroscopy due to food obstruction was reported. Read More

Gastrointest Endosc Clin N Am 2018 Jan;28(1):97-110

Division of Digestive Diseases & Nutrition, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida Morsani College of Medicine, 12901 Bruce B. Downs Boulevard, MDC 72, Tampa, FL 33612, USA. Electronic address:

In eosinophilic esophagitis, the main cause of solid-food dysphagia is tissue remodeling resulting in strictures and narrowed esophagus. Endoscopy and biopsies help to identify the degree of inflammation but often miss the fibrosis. Although initially considered dangerous, esophageal dilation has evolved into an extremely effective and safe treatment in fibrostenotic disease. Read More

J Biomed Res 2017 Jan;31(2):82-94

Department of Medicine, Division of Cardiology, College of Human Medicine, Michigan State University, East Lansing, MI, USA.

Cholesterol crystal embolic (CCE) syndrome is often a clinically challenging condition that has a poor prognostic implication. It is a result of plaque rupture with release of cholesterol crystals into the circulation that embolize into various tissue organs. Plaque rupture seems to be triggered by an expanding necrotic core during cholesterol crystallization forming sharp tipped crystals that perforate and tear the fibrous cap. Read More

Rev Esp Enferm Dig 2017 Jul;109(7):537

Radiología, Agencia Sanitaria Alto Guadalquivir. J Andalucía.

We present a case of a young 16 year old patient that had an esophageal perforation in the context of eosinophilic esophagitis. The esophagus showed vertical lacerations and mucosal thickness on endoscopy, thus a biopsy was performed in the proximal section which resulted in profuse bleeding due to a deep mucosal tear. A subsequent computed tomography scan revealed a perforation. Read More

Endoscopy 2017 Sep 31;49(9):848-854. Epub 2017 May 31.

Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia.

Chemoradiotherapy for head and neck cancer (HNC) with/without laryngectomy commonly causes dysphagia. Pharyngoesophageal junction (PEJ) stricturing is an important contributor. We aimed to validate a functional lumen imaging probe (the EndoFLIP system) as a tool for quantitating pretreatment PEJ distensibility and treatment-related changes in HNC survivors with dysphagia and to evaluate the diagnostic accuracy of EndoFLIP-derived distensibility in detecting PEJ strictures. Read More

Gastrointest Endosc 2017 10 28;86(4):733-734. Epub 2017 Apr 28.

Department of Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

J Neurosurg Spine 2017 May 3;26(5):560-566. Epub 2017 Feb 3.

Institute of Clinical Orthopedic and Neurosciences, Desert Regional Medical Center, Palm Springs, California.

Anterior cervical discectomy and fusion (ACDF) is a very common surgery performed globally. Although a few cases of expectorating screws or extrusion of screws into the gastrointestinal tract through esophageal perforations have previously been reported, there has not been a case reporting pharyngeal perforation and entire cervical construct extrusion in the literature to date. In this report the authors present the first case involving the extrusion of an entire cervical construct via a tear in the posterior pharyngeal wall. Read More

Rev Esp Enferm Dig 2017 Jan;109(1):65-66

Aparato Digestivo, CHUS.

A 47-year-old man was attended at the emergency room for severe chest pain after eating sausage with subsequent vomiting and mild upper gastrointestinal bleeding. In the chest radiography we could not see abnormalities. He referred previous episodes of choking without consulting. Read More

Comp Med 2016 ;66(5):399-404

Department of Veterinary Medicine and Surgery, Division of Basic Science Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

A 5.5-mo-old castrated, male Red Duroc pig presented acutely with depression and abdominal pain 9 d after an altercation with another pig. A CT examination indicated right pneumothorax and herniation of the stomach into the thoracic cavity. Read More

Ann Thorac Surg 2016 Nov 15;102(5):1536-1542. Epub 2016 Jun 15.

Department of Radiology, Mie University Hospital, Mie, Japan.

Background: Type A aortic dissection (TAAD) is a rare complication associated with thoracic endovascular aortic repair (TEVAR). Although TAAD can result in catastrophic outcomes, the pathology of the condition has not been thoroughly clarified yet.

Methods: We retrospectively reviewed details from the medical records of 546 patients with diseases of the thoracic aorta (thoracic aortic aneurysm, n = 362; aortic dissection, n = 178; and fistula between the descending thoracic aorta and esophagus, n = 6) who underwent TEVAR in five hospitals from May 1997 through February 2015 to identify patients in whom TAAD developed during or after TEVAR. Read More

Neuro Endocrinol Lett 2016 Jul;37(3):184-188

Centogene AG, Rostock, Germany.

We report a young woman with the clinical picture of Allgrove syndrome in whom neurological symptoms are prominent. It usually presents in the first decade of life with a deficiency of tears, recurrent vomiting and dysphagia due to achalasia, severe hypoglycemic seizures and shock due to adrenal insufficiency. Neurological symptoms such as hyperreflexia, dysarthria, hypernasal speech, ataxia, sensory impairment, muscle weakness, and mental retardation are extremely slow to develop and manifest at a later age. Read More

Rev Esp Enferm Dig 2016 Mar;108(3):156-7

Radiología, Hospital de Bellvitge, España.

A 35-year-old man, with a history of rhinitis, eczema and a dubious achalasia was admitted due to chest pain and sialorrhea. Upper endoscopy showed a little hole and a narrowing of the distal esophagus. A CT-scan with oral contrast exposed a discontinuity of the lumen of the middle third of the esophagus and a dissection of submucosal space 16 cm long. Read More

Pediatr Gastroenterol Hepatol Nutr 2015 Dec 23;18(4):224-9. Epub 2015 Dec 23.

Department of Pediatrics, NSCB Medical College, Jabalpur, India.

Cyclic vomiting syndrome (CVS) is a functional disorder characterized by stereotypical episodes of intense vomiting separated by weeks to months. Although it can occur at any age, the most common age at presentation is 3-7 years. There is no gender predominance. Read More

J Clin Gastroenterol 2015 Nov-Dec;49(10):848-52

*Division of Gastroenterology and Hepatology, Drexel University College of Medicine, Philadelphia, PA †Department of Internal Medicine, University of Maryland, College Park, MD.

Goal: To determine if esophagogastroduodenoscopy (EGD) before transesophageal echocardiography (TEE) will change patient management.

Background: Before TEE gastroenterologists are often consulted to evaluate patients with a history of dysphagia, known gastrointestinal (GI) disease, or GI bleed. There are no known published data on the clinical utility of EGD before TEE. Read More

Endoscopy 2014 14;46 Suppl 1 UCTN:E471. Epub 2014 Oct 14.

Department of Radiology, Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey.

Eur J Cardiothorac Surg 2013 Apr 7;43(4):e105. Epub 2013 Jan 7.

Department of Surgery, Division of Thoracic Surgery, School of Medicine, Changhua Christian Hospital, National Yang-Ming University, Taipei, Taiwan.

Radiol Case Rep 2013 7;8(2):433. Epub 2015 Dec 7.

Boerhaave syndrome, or spontaneous rupture of the esophagus, is a complication of violent vomiting. Although the syndrome is rare, awareness of it is important because delayed or missed diagnosis can be fatal. Radiographic imaging, particularly computed tomography, is the mainstay of diagnosis, and endoscopy generally does not play a role. Read More

J Emerg Med 2012 Sep 12;43(3):423-7. Epub 2011 Jun 12.

Department of Emergency Medicine, Chang Gung Memorial Hospital at Kaohsiung, College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Background: Foreign body (FB) ingestion is a common problem presenting to the emergency department (ED). The standard treatment, removal by endoscopy, is well established. However, some patients may refuse this invasive procedure due to their fear of an uncomfortable or painful experience. Read More

Spine (Phila Pa 1976) 2011 May;36(12):E798-802

Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.

Study Design: We present a unique case of a 54-year-old woman who developed a prevertebral abscess 2 years after anterior cervical fusion in the absence of previously reported risk factors for late infection. The literature relevant to this topic is reviewed.

Objective: To report a rare complication of a commonly performed surgery. Read More

Korean J Radiol 2010 Mar-Apr;11(2):203-10. Epub 2010 Feb 22.

Department of Radiology, Seoul National University College of Medicine and the Institute of Radiation Medicine, SNUMRC, Seoul 110-744, Korea.

Objective: We retrospectively evaluated the effectiveness of the esophageal balloon dilatation (EBD) in children with a corrosive esophageal stricture.

Materials And Methods: The study subjects included 14 patients (M:F = 8:6, age range: 17-85 months) who underwent an EBD due to a corrosive esophageal stricture. The causative agents for the condition were glacial acetic acid (n = 9) and lye (n = 5). Read More

Am J Otolaryngol 2010 Jul-Aug;31(4):276-8. Epub 2009 May 17.

Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS 39216, USA.

Objectives: To present a pediatric case of spontaneous tracheal rupture caused solely by vomiting and to discuss its diagnosis and management.

Study Design: Case presentation and literature review.

Results: A 14-year-old girl with a new diagnosis of type 1 diabetes mellitus presented with respiratory distress. Read More

J Chin Med Assoc 2009 Sep;72(9):498-500

Department of Emergency Medicine, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan, ROC.

Acute chest pain can indicate a life-threatening condition and it is important for physicians to diagnose and treat it as a matter of urgency. We report 1 rare case of esophageal intramural hematoma (IMH) that presented with chest pain at the emergency department and which was initially clinically suspected to be due to aortic dissection. The case was diagnosed preoperatively by multidetector computed tomography. Read More

Endoscopy 2009 15;41 Suppl 2:E240. Epub 2009 Sep 15.

Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, Korea.

J Pediatr Surg 2009 Jun;44(6):1292-4

Monroe Carell Jr, Children's Hospital at Vanderbilt, Nashville, Tenn 37232, USA.

Blunt force trauma to the neck can result in the unusual injury pattern of laceration of the posterior tracheal wall in combination with esophageal injury. We present the report of a 10-year-old child who had blunt cervical trauma because of a bicycle accident and subsequently presented with profound subcutaneous emphysema. This case was addressed with operative management with a good result. Read More

Emerg Med J 2009 Jun;26(6):461-2

Weston General Hospital, Grange Road, Uphill, Weston-Super-Mare, UK.

Boerhaave's syndrome, or post-emetic rupture of the oesophagus, classically presents with vomiting, chest pain and subcutaneous emphysema. Mortality in this condition is very high and increases dramatically with delayed diagnosis and intervention. The vast majority of patients have a tear in the left posterior-lateral wall of the lower third of the oesophagus and require urgent surgical intervention. Read More

Emerg Radiol 2008 Jan 20;15(1):13-22. Epub 2007 Oct 20.

Department of Radiology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.

Intramural hematoma of the esophagus (IHE) is a rare but well-documented condition that is part of the spectrum of esophageal injuries which includes the more common Mallory-Weiss tear and Boerhaave's syndrome. Acute retrosternal or epigastric pain is a common clinical feature, which can be accompanied by dysphagia, odynophagia, or hematemesis. An early differentiation from Mallory-Weiss tear, Boerhaave syndrome, ruptured aortic aneurysm, aortic dissection, acute myocardial infarction, or pulmonary pathology can be difficult. Read More

Eur Spine J 2007 Dec 14;16 Suppl 3:278-82. Epub 2007 Aug 14.

Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.

This study relates to the case report of a neurologically intact 13-year-old boy with unrecognized traumatic bipedicular vertebral fracture. He was diagnosed complete vertebral body luxation 1 day later by dynamic fluoroscopy, then successfully treated with surgery that resulted in total recovery. The delayed diagnosis highlights the importance of detailed initial clinical and radiology examinations, even when overt symptoms as diagnostic indicators of severe neurological sequelae expected in similar traumatic vertebral fractures are lacking. Read More

Surg Neurol 2007 May;67(5):499-503; discussion 503

Department of Neurosurgery, San Sebastiano Hospital, 81100 Caserta, Italy.

Background: Transient dysphagia after anterior cervical discectomy is not uncommon. It is usually related to esophageal edema secondary to retraction, mechanical adhesions of the esophagus to the anterior spine, and stretch injuries to nerves involved in the swallowing mechanism. Structurally induced dysphagia, secondary to laceration of the neck viscera or to the presence of retropharyngeal masses, is by far less frequent, and it does not usually improve over time. Read More

Gastrointest Endosc 2007 Apr;65(4):684-7

University of Pennsylvania Health System, Philadelphia, PA, USA.

Background: Intralumenal full-thickness gastric resection (FTGR) could be useful as a biopsy technique or in the management of gastric neoplasms. SurgASSIST is a cutting and stapling device delivered on a steerable shaft to which interchangeable stapling units are affixed.

Objective: This feasibility study assessed the applicability of the SurgASSIST to perform intralumenal FTGR in a swine model. Read More

J Spinal Disord Tech 2006 May;19(3):199-203

Department of Neurosurger, The Medical Center of Central Georgia, Mercer University School of Medicine, Macon, GA 31201, USA.

In this case report of a screw extrusion into the gastrointestinal tract of a patient 16 months after anterior cervical discectomy and fusion (ACDF), the authors describe a rare but potentially lethal complication and review the literature on this topic. A 70-year-old white man with a surgical history of ACDF at C3-4 underwent an ACDF at C5-6 with autologous bone graft and a dynamic plate using locking, expanding screws. Sixteen months after the operation the patient presented with severe dysphagia. Read More

J Vasc Interv Radiol 2005 Dec;16(12):1699-704

Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea.

Purpose: To evaluate the safety and clinical effectiveness of fluoroscopically guided balloon dilation in 62 patients with benign anastomotic stricture after Ivor-Lewis esophagectomy.

Materials And Methods: Between January 1996 and June 2004, fluoroscopically guided balloon dilation was undertaken in 62 patients with benign anastomotic stricture after Ivor-Lewis esophagectomy. Radiologic images and medical records including complications were retrospectively reviewed. Read More

Dis Esophagus 2005 ;18(6):406-9

Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55901, USA.

A 54-year-old man presented to the ER with chest pain. He underwent an upper endoscopy revealing a large linear esophageal tear and a CT chest showed free air in the mediastinum. He was managed conservatively and was discharged 2 days later. Read More

Int J Cardiol 2006 Jan;106(2):262-3

Cardiac Ultrasound Laboratory, VBK508 Massachusetts General Hospital, Harvard Medical School, Boston, 02114, USA.

A 28 year old woman underwent echocardiography following an incidental finding of a diastolic murmur. She has been taking phentermine for weight reduction for 8 months. Trans-esophageal echocardiography revealed a tear of the posterior cusp of the aortic valve causing severe regurgitation. Read More

J Endovasc Ther 2005 Oct;12(5):574-8

Center for Vascular Disease, University of Rochester, New York 14642, USA.

Purpose: To report our early experience with the endovascular placement of stacked Zenith main body extensions (cuffs) in the treatment of focal thoracic aortic pathology in high-risk patients.

Methods: Between January 2003 and May 2004, 6 patients (3 men; mean age 59 years, range 37-82) with focal aortic pathology underwent endovascular repair using stacked 30 and 32-mm-diameter Zenith main body extensions. The setting was a university tertiary referral center for vascular disease. Read More

Eur J Cardiothorac Surg 2005 Sep;28(3):502-3

Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria.

A 21-year-old female with chronic membranoproliferative nephritis was admitted for suspected esophageal disruption and asthma after severe, prolonged vomiting. At the time of admission she presented with dyspnea, tachypnea, arterial hypotension and tachycardia. Physical examination showed discrete signs of ectopic air at the neck and distended cervical veins. Read More

Trop Gastroenterol 2004 Jan-Mar;25(1):42-3

Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi.

Oesophageal perforation is the most life threatening of all digestive perforations. External blunt trauma is a rare cause of oesophageal perforation. An 8-years old boy sustained blunt trauma to the chest and abdomen, which led to splenic tear and oesophageal rupture. Read More

Nihon Kokyuki Gakkai Zasshi 2003 Jul;41(7):502-5

Department of Respiratory Medicine, Fujisawa City Hospital.

A 75-year-old man was seen in the Emergency Room of our hospital because of chest pain after drinking beer and vomiting. Chest radiography showed pleural effusion in the left pleural space. The drained effusion contained digested food. Read More

J Spinal Disord Tech 2002 Dec;15(6):513-8

Department of Orthopedics, Hôpital Maison Blanche, Reims, France.

We present a posttraumatic esophageal tear that occurred in a 55-year old patient after a truck accident. He sustained a two-level injury with a type II odontoid fracture and a unilateral fracture of the left superior articular process of C6 with an incomplete quadriplegia at C5. Both lesions were treated nonoperatively. Read More

Am Surg 2002 Jan;68(1):36-40

Department of Surgery, Medical College of Georgia, Augusta 30912, USA.

Definitive repair of esophageal perforation is considered the preferred treatment for patients presenting early (<24 hours). However, the optimal management of delayed presentation (>24 hours) has not been well defined. This study examined the management of esophageal perforation and compared the outcomes of early versus delayed presentation. Read More

Int J Clin Pract 2002 Apr;56(3):225-6

Department of Geriatrics, Glanclwyd Hospital, Rhyl, Denbighshire, UK.

Submucosal haematoma of the oesophagus is an uncommon condition which may be under-recognised. Presentation may be with chest pain, dysphagia or haematemesis. Endoscopy, CT scan, barium meal or a combination of these modalities makes the diagnosis. Read More

Anasthesiol Intensivmed Notfallmed Schmerzther 2002 Apr;37(4):222-4

Klinik für Anästhesiologie.

Injuries after a close contact gunshot with clear or tear gas cartridges can lead to severe and life threatening complications. The high pressure of the gas may damage soft tissue, bones and organs. This mechanism is able to cause mediastinal emphysema, rupture of upper and lower pharyngeal, esophageal and tracheal structures far away from the initial trauma with diagnostic findings which are may be difficult to interpret. Read More

Can J Anaesth 2002 Apr;49(4):409-12

Department of Anaesthesiology and Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Purpose: To report a case of spontaneous rupture of the esophagus and its anesthetic management.

Clinical Features: A 52-yr-old male presented with a seven day history of chest pain, respiratory distress, and swelling in the neck following forceful vomiting. Examination revealed hypotension, decreased air entry in the right lower lung field with crepitations, epigastric tenderness with abdominal distension and guarding of both right and left hypochondria. Read More

J Cardiovasc Surg (Torino) 2002 Apr;43(2):295-7

Department of Pediatric Surgery, Cumhuriyet University, Faculty of Medicine, Sivas, Turkey.

A 5-month-old boy who had been operated for esophageal atresia and tracheoesophageal fistula was presented with recurrent life-threatening apneic spells, expiratory stridor and difficulty in feeding. Diagnosis of tracheomalacia was confirmed by bronchoscopy and pericardial flap aortopexy was performed. Pericardial flap aortopexy is a relatively simple procedure with minimal risk to the aorta. Read More

J Pediatr Surg 2002 Jan;37(1):E1

The Hospital for Sick Children, Division of General Surgery, Room 1526, 555 University Ave, Toronto, Ontario, Canada M5G 1X8.

In August 1996, a 7-year-old boy was crushed from behind into the steering wheel of a go-cart, suffering a tear of his right innominate artery into the aortic arch, a 2-inch tear of the posterior trachea into left main bronchus, and 2 4-inch tears in the esophagus. These were all repaired on cardiopulmonary bypass through a sternotomy; a Gor-tex (W. L. Read More