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Perforation after rigid pharyngo-oesophagoscopy: when do symptoms and signs develop?

Published online by Cambridge University Press:  20 October 2009

M Daniel ,
T Kamani ,
C Nogueira ,
M-C Jaberoo ,
P Conboy ,
M Johnston  and
P Bradley
M Daniel*
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Nottingham, UK
T Kamani
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Derbyshire Hospitals, Derby, UK
C Nogueira
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Derbyshire Hospitals, Derby, UK
M-C Jaberoo
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, St Bartholomew's Hospital, London, UK
P Conboy
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, University Hospitals Leicester, UK
M Johnston
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, Derbyshire Hospitals, Derby, UK
P Bradley
Affiliation:
Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Nottingham, UK
*
Address for correspondence: Mr Mat Daniel, Otorhinolaryngology Head and Neck Surgery, University Hospital Nottingham, Derby Road, Nottingham NG7 2UH, UK. Fax: 0115 970 9748 E-mail: mat.daniel@nuh.nhs.uk
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Abstract

Background:

Perforation after pharyngo-oesophagoscopy is a serious complication, and its identification, through close patient monitoring, is essential. Yet little is known about when symptoms and signs develop, and thus how long any close monitoring should last.

Aim:

To examine the timing of individual symptoms and signs of perforation after rigid pharyngo-oesophagoscopy.

Methodology:

Three-centre, retrospective study.

Results:

Of 3459 patients undergoing rigid pharyngo-oesophagoscopy, 10 (0.29 per cent) developed perforations, nine of which were suspected intra-operatively. Symptoms and signs developed at 1.5 hours post-operatively at the earliest, and at 36 hours at the latest. Three patients were asymptomatic. The majority of procedures (n = 8) were undertaken for food bolus obstruction or foreign body ingestion.

Conclusion:

Pharyngo-oesophagoscopy for food bolus obstruction and foreign body ingestion accounts for a large number of perforations, but symptoms and signs may take longer than 24 hours to develop. A contrast swallow should be considered in high risk patients, and a high index of suspicion maintained in order to detect this complication.

Keywords

OesophagoscopyOesophageal PerforationComplications
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 2 , February 2010 , pp. 171 - 174
Copyright
Copyright © JLO (1984) Limited 2009

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Footnotes

Presented as a poster at the British Academic Conference in Otolaryngology, 8–10 July 2009, Liverpool.

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