babli
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A 29-year-old man comes to the emergency department complaining of back pain. The pain began the previous afternoon when the man choked on a chicken bone. He describes the pain as sharp and located between his shoulder blades. Now he is also having shaking chills. The man appears ill and confused. Vital signs are temperature 39.4°C (102.9°F), blood pressure 90/60 mm Hg, heart rate 127 beats/minute, and respiratory rate 30 breaths/minute. Which of the following is the most appropriate management for this patient’s condition?
A. Barium swallowing study
B. Drainage, esophageal diversion, and antibiotics
C. Esophageal end-to-end anastomosis and antibiotics
D. Simple esophageal repair, drainage, and antibiotics
E. Upper endoscopy
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| p53
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not sure - B. or D. - others are clearly wrong.
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"Everything should be made as simple as possible, but not simpler." - Albert Einstein
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| achilles
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i'll go for D.
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" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
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| mesh
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A??....first we should confirm the diagnosis.....not sure....
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| p53
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barium will go out of the perforated esophagus!
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"Everything should be made as simple as possible, but not simpler." - Albert Einstein
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| babli
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Option B (Drainage, esophageal diversion, and antibiotics) is correct. The patient almost certainly has a ruptured esophagus. Anastomosis is appropriate on reconstruction. Because treatment has been delayed, there will be edema and inflammation of the damaged tissue, which will prevent primary simple repair. Esophageal diversion should be performed, with later reconstruction.
Option A (Barium swallowing study) is incorrect. The patient almost certainly has a ruptured esophagus. A barium swallow will result in leakage of barium into the mediastinum among other undesirable consequences. This action may prove fatal.
Option C (Esophageal end-to-end anastomosis and antibiotics) is incorrect. The patient almost certainly has a ruptured esophagus. Anastomosis is appropriate on reconstruction. Because treatment has been delayed, there will be edema and inflammation of the damaged tissue, which will prevent primary simple repair. Esophageal diversion should be performed, with later reconstruction.
Option D (Simple esophageal repair, drainage, and antibiotics) is incorrect. The patient almost certainly has a ruptured esophagus. Simple repair is advised only if treatment is initiated early. Because treatment has been delayed, there will be edema and inflammation of the damaged tissue, which will prevent primary simple repair.
Option E (Upper endoscopy) is incorrect. The patient almost certainly has a ruptured esophagus. Confirmation of diagnosis can be made by other means, and the procedure is likely to worsen the esophageal tear. Indeed, upper endoscopy is one of the leading causes of an esophageal tear.
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| mesh
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is barium swallow CI in esophageal rupture.......????
well we do contrast studies in boerhaave syndrome.....it is also esophageal rupture
put some light on it..thanks......
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| babli
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The use of barium in patients affected with Boerhaave syndrome has been associated with severe mediastinitis. This complication may contribute significantly to increased morbidity and mortality.
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| mesh
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what is the best way to diagnose esophageal rupture......????
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| babli
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we use a water-soluble contrast such as Gastrografin. It has 90% sensitivity.
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| mesh
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thanks.......
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