• Journal of Chest Surgery
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• v.44 no.4
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• pp.311-313
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• 2011

Hemangiomas that arise in cervical esophagus are extremely rare, representing 3.3% of all benign esophageal tumors. Although endoscopic mucosal resection (EMR) and potassium titanyl phosphate/yttrium aluminum garnet (KTP/YAG) laser therapy have been used with success for small tumors, the safety and efficacy in the case of large tumors remains uncertain. We report the successful resection of cervical esophageal hemangioma through a cervical esophagotomy in a patient with thyroid cancer who needed a cervical collar incision.

• Journal of Chest Surgery
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• v.16 no.1
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• pp.121-126
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• 1983

8 cases of the esophageal perforations were treated at the department of thoracic surgery, Chungnam National University Hospital during the period from July, 1980 to Dec., 1982. The causes of the perforation were various; swallowed a piece of glass, stocking pin, coiled wire, compressed air blow, strenuous vomiting, dog bite, tiller accident, and endoscopic procedure. The perforation sites were cervical esophagus in 3 cases, upper thoracic in 2 cases and lower thoracic in remains. We have performed following surgical procedure; Incision and drainage for cervical abscess, closed thoracostomy, thoracotomy and debridement, esophagoscopy and gastrostomy. Two cases were died. The causes of death were massive bleeding and sepsis.

• Journal of Chest Surgery
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• v.23 no.6
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• pp.1233-1237
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• 1990

When the perforation of intrathoracic esophagus occurs in the presence of preexisting esophageal stricture, aggressive and definitive therapy often provides the only chance for patient salvage. Two adults suffering from intrathoracic esophageal perforation with underlying stricture underwent transhiatal esophagectomy. The perforations were due to esophageal instrumentation. Restoration of alimentary continuity with a primary cervical pharyngogastric anastomosis was carried out in one patient. Another patient underwent a cervical esophagostomy and had a subsequent colonic interposition 3 months later.

• Korean Journal of Head & Neck Oncology
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• v.7 no.2
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• pp.120-128
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• 1991

Reconstruction of the pharynx and cervical esophagus presents a tremendous surgical challenge to the Head and Neck Surgeon. Because life expectancy of patients with advanced carcinoma of the hypopharynx, and cervical esophagus is limited, treatment must be aimed at palliation. A variety of techiques have been proposed over the years with none proving entirely satisfactory. These techiques include prosthesis; skin graft; cervical flaps; tubed cutaneous and myocutaneous chest flaps; visceral reconstruction with stomach, colon. and jejunum; and jejunal free autografts. Many factors dictate the best method of reconstruction in any given clinical situation. The goal of the surgery is a one-stage reconstruction of swallowing function with minimal morbidity to allow as short a hospital stay as posible. Nine patients underwent the free jejunal autograft reconstruction of the pharyngoesophagus after the ablative surgery for the advanced hypopharyngeal cancer. Postoperative complications included one perioperative death, two abdominal wound dehiscences, two neck hematomas, one carotid rupture, one funtional dysphagia, one late strictures. There were no graft failure, no immediate stenosis and no fistula. An oral diet was started between days 8 and 16, with an average of 9 days and median of 8 days. Patients left the hospital between days 9 and days 38, with an average of 23.4 days and median of 23 days. This method of reconstruction is advocated as reliable palliative procedure with short-term follow-up. In conclusion, we at Korea Cancer Center Hospital are of the opinion that the free jejunal autograft offers an excellent, safe and relative easy method of the pharyngeal and cervical esophageal reconstruction with significant advantages over other techiques.

• Journal of Chest Surgery
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• v.24 no.12
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• pp.1232-1237
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• 1991

The cervical esophageal stricture has various surgical modalities and difficulties in reconstruction. We had experienced a case of successful reconstruction of the cervical esophageal restenosis using the free jejunal graft, on 30 year old man had had esophageal stricture after ingestion of lye. He had undergone colon interposition[esophagocologastrostomy] with left colon feeding gastrostomy. But restenosis was occurred just above of the cervical esophagocolostomy site several times of balloon dilatation were failed. So, we decided to use of the free jejunal graft. The free jejunal graft was isolated about 15cm length with it`s vascular arcades. The graft was irrigated with the mixed solution as isotonic saline, heparin and papaverine chloride. The artery of graft was anastomosed to the branch of the external carotid artery in end to side with continuous sutures of the 8.0 Prolene. The vein of the graft was anastomosed to the branch of the anterior facial vein in end to end with continuous sutures of the 8.0 prolene. Postoperative course was uneventful and the patient was discharged after removal of the tracheostomy cannula and gastrostomy tube.

• Journal of Chest Surgery
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• v.23 no.2
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• pp.285-298
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• 1990

The records of 67 patients who had been operated as an esophageal cancer during the period from 1973 to 1989 at the Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital were reviewed retrospectively. The results were summarized as follows ; The age ranged from 28 years old to 80 years old. The highest incidence was 5th decades, then 6th decades, and the incidence of male was 10 times as the incidence of female[M:F= 10.16: 1]. The locations were lower esophagus 44%, middle esophagus 38.8%, upper esophagus 11.9% and cervical esophagus 4.4% The frequent symptoms were dysphagia [88%], epigastric or substernal pain and discomfort [29.8%], weight loss [20.8%], and laryngeal dryness [1.4%]. The most common interval between the onset of dysphagia and admission was 2-3 months; 82% of patients was within 6 months, The cancer consisted of stage I [3%], stage II [11.9%], stage III[47.6%], and stage IV [33.7%] The resectability of cancer was 67%. The organs of substitute were stomach in 21 cases, right colon 6 cases, and jejunum in 8 CRSCS. The relation between invasion of tumor and lymph node metastasis was analyzed: mucosal involvement: 1 case/2case, muscle invasion; 0/2 full thickness; 4/6, adjacent structure 7/12. Postoperative complications were pneumonia, pleural effusion, hoarseness, mediastinitis, anastomosis site leakage, reoperation due to stenosis, chylothorax, empyema, mechanical ileus, wound infection, meat impaction at anastomosis site, and repair of gastrostomy site leakage. Adjuvant therapies were irradiation [15cases], chemotherapy [14cases], and Bougie dilatation [4 cases],

• Journal of Chest Surgery
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• v.39 no.2 s.259
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• pp.111-116
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• 2006

Background: Perforation of the esophagus is a deadly injury that requires expert management for survival. The mediastinal contamination with microorganisms, gastric acid, and digestive enzymes results in a mediastinitis that is often fatal if untreated. Material and Method: Between January 1990 and June 2004, 38 patients with esophageal perforation were treated in our hospital. Retrospective review of these cases has been performed. Result: There were 28 males and 10 females. The mean age was 43.84$\pm$18.89 years (range $1{\~}73$ years). Spontaneous rupture was found in $34\%$ of perforations, iatrogenic perforation in $32\%$ and traumatic perforation in $34\%$. Perforation occurred in the cervical esophagus in 8 cases, thoracic esophagus in 29 and abdominal esophagus in 1. In the cervical esophageal perforation, managements were primary closure in 8 and drainage in 2. In the thoracic esophageal perforation, managements were primary closure in 14, resection in 3 and conservative management in 12. The mortality rate was $25\%$ in cervical esophageal perforation and $34.5\%$ in thoracic esophageal perforation. We revealed risk factor of esophageal perforation to be peropertaive septic condition (p=0.005). Conclusion: Most important risk factor of esophageal perforation was preoperative septic condition. Preoperative prompt and aggressive preoperative treatment may improve the survival rate of esophageal perforation.

• Journal of Chest Surgery
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• v.2 no.2
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• pp.147-154
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• 1969

This is a report on a total of 11 cases of esophageal perforation in the department of thoracic surgery, Chonnam University Hospital during the period of 8 years from 1962 to 1969. They occurred by the following agents, that is,lye solution[7 cases], fish bone[2 cases]. compress air [one case], strong acid [one case]. The perforated portions of esophagus were cervical esophagus in 2 cases, upper third of esophagus in 5 cases, middle third of esophagus in 3 cases and lower third of esophagus [abdominal esophagus] in one case. 4 cases out of cases of esophageal perforation after ingestion of Lye solution were due to Bougination to improve esophageal stenosis: 2 cases occurred 2 months after ingestion of Lye solution and the remaining 2 cases, 2 to 3 weeks after Lye solution ingestion. Therefore, It is realized that Bougination for esephageal stricture by Lye solution is particularly dangerous. The complication after esophageal perforation were mediastinitis,[10 cases], right pyothorax with mediastinitis [8 cases], peritonitis [4 cases], esophago-bronchial fistula[one case]. Owing to the various complications above mentioned, surgical approach to esophageal perforation is accordingly complicated and a combination of more than two of the following different procedures were properly used case by case, that is. gastrostomy or jejunostomy for feeding and esophageal rest,thoracotomy and chest drainage, lung decortication for pyothorax, primary closure of compress air perforation and esophago-bronchial fistula, mediastinostomy, retrosternal esophagoplasty using right colon to Lye stricture etc. 5 cases[45. 5%] of 11 cases were expired and the rest of 6 cases[54.5%]were survived with complete accomplishment of surgical procedures and satisfactory healing in 4 cases and interruption of follow up in 2 cases because of poor economical condition of the patients.

• Journal of Chest Surgery
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• v.14 no.1
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• pp.77-82
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• 1981

The esophageal perforation is the most rapidly fatal and most serious perforation of the gastrointestinal tract. The 53 year old male patient was admitted because of substernal and epigastric pain altar esophageal bougienage for the indigestion and the difficult swallowing before about 18 hours. On esophagogram, there was the extravasation of contrast media at the right side of the lower esophagus [retrocardiac segment]. The emergency thoractotomy, debridement and suture closure with drainage were performed. But after 7 days the esophageal leakage was complicated again with pus discharge, although primary repair was done. On the 13th hospital day, the temporary cervical esophageal fistulation with dual drainages was made under general anesthesia. On the 38th day after this procedure, the esophageal leakage was closed spontaneously. On the 63rd hospital day the cervical fistulation was repaired and ever since the esophageal passage was good without leakage or swallowing difficulty.

• Journal of Chest Surgery
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• v.5 no.1
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• pp.45-56
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• 1972

Esophageal perforation is one of the most grave prognostic problems among thoracic and general surgical emergencies which necessitate urgent operative measures. In Korea,there are still many persons ingesting lye for suicidal attempt and thoracic surgeons in Korea have more chances to deal with lye burned esophagus with or without instrumental perforation than those in Western countries. Main cause of esophageal perforation in Korea is instrumental perforation in patients with lye stricture of the esophagus during diagnostic endoscopy or therapeutic bouginage. Other causes are corrosion of the esophagus due to ingestion of caustic agents, pathologic perforation, surgical trauma, stab wound and spontaneous rupture of the esophagus in our series. Therapeutic measures are various,and depend on duration of perforation, severity of its complications, pathology of perforated portion of the esophagus and degrees of inflammation at the point of perforation. The most important therapeutic measures are prevention of this grave condition during esophagoscopy, bouginage and surgical procedures on lungs and mediastinal structures and to make early diagnosis with prompt therapeutic measures. During the period of January, 1959, to December, 1971, the authors experienced 65 cases ofesophageal perforation including acquired esophagorespiratory fistula at Dept. of Chest Surgery, the National Medical Center in Seoul, and obtained following results in the series. 1. Female were 35 cases, and peak age incidence was 2nd and 3rd decades of life. 2. Among 65 cases, 43 were corrosive esophagitis or benign stricture of the esophagus due to caustic agents, 7 were patients with esophageal cancer. and there were 5 cases of esophageal perforation developed after pneumonectomy or pleuropneumonectomy. 3. Causes of perforation are instrumental perforation in 45, acute corrosion in 7, pathologic perforation in 7, surgical trauma in 3, stab wound in 2 cases, and one spontaneous rupture of the esophagus. 4. Most frequent sites of esophageal perforation were upper and mid thoracic esophagus, and 8 were cases with cervical esophageal perforation. 5. Complications of esophageal perforation were mediastinitis in 42, empyema or pneumothorax in 35, esophagorespiratory fistula in 12, retroperitoneal fistula or abscess in 5,pneumoperitoneum in 3, and localized peritonitis in 1 case. 6. Cases with malignant esophagorespiratory fistula were only 3 in the series which is predominant cause of acquired esophagorespiratory fistula in Western countries. 7. Various therapeutic measures were applied with mortality rate of 27.7% in the series. 8. In usual cases early treatment gave better prognosis, and least mortality rate in cases with perforation in mid thoracic esophagus. 9. Main causes of death were respiratory complications,acute hemorrhage with asphyxia, and septic complications. 10. Esophageal perforation developed after pneumonectomy gave more difficult therapeutic problems which were solved in only 1 among 5 cases.