International Medical Journal, Vol. 23., Iss. 4, 2017, P. 35−37.
MODERN APPROACHES TO TREATMENT OF SPONTANEOUS ESOPHAGEAL RUPTURE
V. T. Zaitsev Institute of General and Emergency Surgery, NAMS of Ukraine, Kharkiv, Ukraine
Despite the use of a huge range of modern surgical methods for treating spontaneous esophageal rupture, this problem is still relevant, as it is a rare and very serious disease. According to a number of authors, there are 5 (3,1 %) cases of spontaneous rupture per 161 cases of the esophagus perforation of different etiology. The term «spontaneous esophagus rupture» means that the individuals who previously had no diseases of this organ. The aim of the work was to improve the diagnosis and results of treatment of patients with spontaneous rupture of the esophagus. The paper presents the analysis of the results of treatment of 5 patients with spontaneous rupture of the esophagus for the period from 2014 to 2017 at V. T. Zaitsev Institute of General and Urgent Surgery (NAMSU). Stenting of the esophagus was performed with a one−step application of Blackmore probe, which, according to X−ray study, completely blocked the flow of the contrast substance behind the esophagus. To prevent pressure ulcers, repeated deflation of balloons was performed daily. The treatment of patients with esophageal pleural fistula initiated restoration of the adequate enteral nutrition and effective drainage of the pleural cavity. The technique did not result in postoperative complications or deaths. Thus, careful history taking noting the episodes of multiple indomitable vomiting is necessary. The standards of examination of such patients should include X−ray contrast and endoscopic examination of the esophagus (with minimal air inflation) as a method of specifying the diagnosis. Complex surgical treatment of the esophagus injury can reduce the traumatic nature of the surgical intervention, reducing the time of the operation. In the course of treatment, the patients take the nutrition naturally (directly into the stomach through the esophagus, not through the stoma). In this regard, we reduced the rehabilitation time after the surgery, as well as the number of complications and the overall mortality in this group of patients.
Key words: esophagus, spontaneous rupture, external esophageal pleural fistula.