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7 results

  • Chapter 19 - The lost airway

  • from Section 2 - Clinical
  • Edited by Ian Calder, Adrian Pearce
  • Book:
    Core Topics in Airway Management
    Published online:
    10 January 2011
    Print publication:
    16 December 2010, pp 178-188

  • Summary

    Iatrogenic airway injury is mostly caused by laryngoscopy, visualisation of the laryngeal inlet, the placement of a tracheal tube and long-term intubation. Damage to teeth during laryngoscopy is the commonest cause of civil action against anaesthetists. Iatrogenic laryngeal trauma occurs mostly in patients undergoing routine, non-difficult, short-term tracheal intubation. Tracheal intubation-related neuropraxia of the lingual, hypoglossal, and laryngeal nerves have been described. Airway stenosis occurs at any level within the airway following tracheal intubation. Pharyngeal or oesophageal perforation is a serious complication of aerodigestive tract instrumentation, and is associated with a greater severity of injury and risk of mortality than other iatrogenic airway injuries. Trauma to the airway can be broadly classified into two types: external laryngeal trauma which includes blunt and penetrating injuries, and internal airway trauma which includes thermal, caustic and iatrogenic injuries. Non-iatrogenic airway trauma is rare but often life-threatening.

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

  • M Daniel, T Kamani, C Nogueira, M-C Jaberoo, P Conboy, M Johnston, P Bradley
  • Journal:
    The Journal of Laryngology & Otology / Volume 124 / Issue 2 / February 2010
    Published online by Cambridge University Press:
    20 October 2009, pp. 171-174
    Print publication:
    February 2010
  • 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.

  • Oesophageal perforation following ingestion of over-the-counter ibuprofen capsules

  • N P Singh, J G Rizk
  • Journal:
    The Journal of Laryngology & Otology / Volume 122 / Issue 8 / August 2008
    Published online by Cambridge University Press:
    01 May 2008, pp. 864-866
    Print publication:
    August 2008
  • Objective:

    We present a rare case of oesophageal perforation following ingestion of over-the-counter ibuprofen capsules.

    Method:

    Case report and literature review of pill oesophagitis.

    Case report:

    A previously well, 18-year-old man presented with sudden onset, severe, retrosternal pain, dysphagia and odynophagia following ingestion of over-the-counter ibuprofen capsules. Plain X-ray films and a contrast-enhanced computed tomography scan indicated the diagnosis. The patient was successfully treated with non-operative management.

    Conclusion:

    To our knowledge, this is the first report in the world literature concerning oesophageal perforation with ibuprofen. We discuss pill-induced oesophageal injury and its prevention. Manufacturers, clinicians and patients can all take steps to avoid this potentially life-threatening complication.

  • Pharyngeal perforation: a late complication of cervical spine surgery

  • S L Woolley, D R K Smith
  • Journal:
    The Journal of Laryngology & Otology / Volume 119 / Issue 11 / November 2005
    Published online by Cambridge University Press:
    08 March 2006, pp. 913-916
    Print publication:
    November 2005

  • Anterior cervical spine fusion and stabilization is a well-recognized procedure for a number of cervical spine disorders. Unfortunately, the complex anatomy of the cervical spine means that these procedures are not without complications. Pharyngo-oesophageal perforation is a rare but potentially life-threatening complication of cervical spine surgery and may present intra-operatively, in the immediate post-operative period or many years later. We present the case of a gentleman with ankylosing spondylitis who presented with a pharyngeal perforation and fistula five years after cervical spine surgery.