manejo de la perforacion esofagica
TRANSCRIPT
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ADRIANA CARDONA ASTAIZA RESIDENTE CIRUGIA GENERAL U.CES
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PERFORACION ESOFAGICA
MorbilidadMortalidad
SEPSIS INSUFICIENCIA MULTIORGANICA
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VARIABLES MORTALIDAD : DX , REPARO , LOCALIZACION Y ETIOLOGIA
MORTALIDAD POR ETIOLOGIA
ESPONTANEA 39 % IATROGENIA 19 % TRAUMATICA 9 %
MORTALIDAD POR LOCALIZACION
CERVICAL 6 % TORAXICA 34 % INTRAABDOMINAL 29 %
24 HRS
14 VS 27 %
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MORTALIDAD 18 %
Perforation of the Esophagus. Shackelford's Surgery of the Alimentary Tract , Seventh Edition,Charles J. Yeo .Chapter 39, 478-485
CONDICION MEDICA
INTERVALO DX –TTO
CAUSA Y LOCALIZACI
ON
PATOLOGIA SUBYACEN
TE
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AUMENTO PRESION INTRALUMINAL
ENDOSCOPIA RIGIDA VS FLEXIBLE
DX VS TERAPEUTICA
Management of non-iatrogenic traumaticesophageal perforations. Daniel P Raymond, MD
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ESPONTANEA 15 %
TRAUMA CERRADO 0,001%
PENETRANTE 6 % NEUMONECTOMIA HERNIA HIATAL ECO TE
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DOLOR 71 %
FIEBRE 51 %
DISNEA 24 %
CREPITACION 22%
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FIEBRE + DERRAME PLEURAL
DOLOR RETROESTERNAL + EPIGASTRICO
TRIADA DE MACKLER
DOLOR EPIGASTRICO IRRADIADO A HOMBRO Y ESPALDA
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PERIODO CRITICO 24 HRS
RX TAC
EVDA
DIATRIZOATO DE MEGLUMINA VS BARIO
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Perforation of the Esophagus.Shackelford's Surgery of the Alimentary Tract , Seventh Edition,Charles J. Yeo .Chapter 39, 478-485
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DIAGNOSTICO OPORTUNO
REANIMACION
FUNCION CARDIOPULMONAR
CONTROL CONTAMINACION EXTRALUMINAL
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COBERTURA ANTIBACTERIANA
APOYO NUTRICIONAL
RESTAURACION DEL TRACTO GASTROINTESTINAL
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NADA VIA ORAL LEVAMPICILINA SULBACTAM/PIPTAZO/CARBAPENEMFLUCONAZOL
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STENT
DESBRIDAMIENTO Y DRENAJE
MORTALIDAD 5,6 % CUBIERTOS – IATROGENIA INESTABILIDAD
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19 PTES PERFORACION ESPONTANEA 89 % OCLUSION 1/5 MIGRACION INICIO VIA ORAL 3 DIAS
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189 PTES
UNION GASTROESOFAGICA LESION > 6 CM CERVICAL PROXIMAL
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VISUALIZACION DIRECTA
DRENAJE CONTAMINACION
DESBRIDAMIENTO
REPARACION PRIMARIA
RESECCION
DERIVACION
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MENGOLI MORTALIDAD 6 % 21 PTES
MARTINEZ SUPERVIVENCIA 100 %
VOGEL 34 PTES MORTALIDAD 2/6 EXITO 96 %
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PROBLEMAS TECNICOS NECROSIS DIFUSA GRAN TAMAÑO CA –ENFERMEDAD ESOFAGICA INESTABILIDAD HEMODINAMICA
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IATROGENICA O BOERHAAVE
24 HRS
DESBRIDAMIENTO COLGAJOS NUTRICION
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TEJIDO DESVITALIZADO
FALLA REPARACION PRIMARIA
ESOFAGECTOMIA
ESOFAGOSTOMIA CERVICAL
GASTROSTOMIA
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MALIGNIDAD ESTENOSIS DISTAL CAUSTICOS TRANSTORNO DE LA MOTILIDAD
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CERVICAL
DRENAJE REPARACION PRIMARIA
TORAXICO / ABDOMINAL TORACOTOMIA DERECHA –SEXTO ESPACIOIZQUERDA –OCTAVO EIC CELIOTOMIA
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Current Surgical Therapy , Eleventh Edition John L. Cameron, and Andrew M. Cameron .Esophageal Perforation
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Current Surgical Therapy , Eleventh Edition John L. Cameron, and Andrew M. Cameron .Esophageal Perforation
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ENDOSCOPIA INTRAOPERATORIA
SNG VISION DIRECTA
REPARACION PRIMARIA + FUNDOPLICATURA
IRRIGACION
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MALIGNIDAD
DRENAJE
RESECCION-ANASTOMOSIS
RESECCION –ESOFAGOSTOMIA –GASTROSTOMIA
Current Surgical Therapy , Eleventh Edition John L. Cameron, and Andrew M. Cameron .Esophageal Perforation
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ACALASIA
MIOTOMIA
RESECCION
EPIPLON
SNG
Current Surgical Therapy , Eleventh Edition John L. Cameron, and Andrew M. Cameron .Esophageal Perforation
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FUNDOPLICATURA DE NISSEN
CIERRE POR PLANOS
NISSEN
STENTS ????
Current Surgical Therapy , Eleventh Edition John L. Cameron, and Andrew M. Cameron .Esophageal Perforation
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SOPORTE NUTRICIONAL
ATB
ESOFAGOGRAMA
DIA 7
Current Surgical Therapy , Eleventh Edition John L. Cameron, and Andrew M. Cameron .Esophageal Perforation
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DIAGNOSTICO Y MANEJO OPORTUNO IMPACTO EN LA MORBIMORTALIDAD
REPARACION PRIMARIA ESTÁNDAR DE ORO
DRENAJE –CERVICAL
DERIVACION-INESTABILIDAD HEMODINAMICA