1. Esophagitis: Prolonged acid or bile reflux (Gastroesophageal reflux disease GERD) from the stomach can cause injury to the lower esophagus and causing esophagitis. It can be either Erosive esophagitis or Non-erosive reflux disease (NERD). Gastroscopy is usually recommended to document the extent of the injury. Prolonged untreated GERD can cause Barret’s esophagitis, upper GI bleeding or Cancer of the food pipe. Diagnosis usually involves Gastroscopy, 24 hours Phmetry and Esophageal manometry. Medical treatment is very effective and cures almost 100% of patients. Many endoscopic methods are available for the treatment of GERD such as GERDX, Stretta, ARMS etc. Laparoscopic Nissen fundoplication is the surgical treatment for GERD.
2. Difficulty in swallowing food (Dysphagia): It can be due to oesophagal stricture, cancer, webs, or motility disorders. Strictures require dilatation by SG dilators. Motility disorders are diagnosed by esophageal manometry.
The surgical procedure to remove the oesophagus (the tube between your stomach and mouth), partially or completely, and reconstruct it by using a section of the large intestine or stomach is called esophagectomy.
Esophagectomy is commonly used to treat oesophageal cancer.
Early-stage oesophageal cancer is frequently treated with an esophagectomy. Other than that, esophagectomy is also performed to treat oesophageal dysplasia (a condition in which cells in the oesophageal lining are precancerous or likely to develop cancer if not promptly treated).
Esophagectomy is commonly performed when cancer has spread to the stomach, lymph nodes or associated organs.
Some other conditions which require esophagectomy include:
Swallowing of cell-damaging, or caustic agents such as lye.
Problematic stomach disorders that make the passage of food to the stomach difficult.
A previously performed esophagectomy was unsuccessful.
There are three ways a surgeon may perform an esophagectomy, which include:
Transthoracic Esophagectomy (TTE)
In this type of procedure, the incision is made on the chest. A TTE is mostly used to treat the following conditions:
Cancer present only in two-thirds of the oesophagus
Barrett’s oesophagus (Abnormal cell transformation in the lower oesophagus)
Damage to the oesophagus by swallowing a caustic agent
Reflux esophagitis (stomach acids return to the oesophagus) complications
Transhiatal Esophagectomy (THE)
In THE, the incision is made from the end of the breastbone to the bellybutton. THE is performed for the following conditions:
To remove the cancerous oesophagus
To tighten or narrow the oesophagus in order to make swallowing easier
To fix issues in the nervous system
To repair frequent gastroesophageal reflux
Correct a hole in the oesophagus caused by any caustic agent
En Bloc Esophagectomy
In this procedure, the oesophagus, part of the stomach and all the lymph nodes in the abdomen and chest are removed. The incisions are made in the abdomen, chest and neck; the stomach will be reshaped and brought up to the chest to put back the oesophagus.
Potentially curable tumours are treated by en bloc esophagectomy.
Recovery time of esophagectomy is three weeks approximately. You are allowed to go back to your regular diet after a month. You might find that you are eating smaller portions as your stomach size is reduced.
Gangrene is an extremely serious condition in which there is an acute shortage of oxygenated blood to the tissue in the body resulting in tissue necrosis or death. Most of the times, it is seen that Gangrene affects the extremities externally, like feet or hands, but it might also affect the body internally and severely damaging the internal organs.
Types of Gangrene-
There are majorly two broad categories of Gangrene: Wet and Dry.
Wet Gangrene: In this type of fatal Gangrene, there is swelling of the skin along with the appearance of blisters, often accompanied by the formation of pus. It is associated with injuries in diabetic patients. Sometimes, Dry Gangrene deteriorates and manifests itself into Wet Gangrene. This type spreads more quickly from the affected area to other parts of the body due to infection.
Dry Gangrene: Also referred to as mummification, it develops slowly and is often associated with chronic diabetes. Skin becomes shriveled, dry and dark in color, and it feels cold to touch due to tissue death. Moreover, it is also associated with injuries in diabetic patients, with vascular diseases, and with Raynaud’s Disease. Usually, it does not get infected, but if it does, it gets converted into the more dangerous Wet form.
Symptoms of Gangrene include-
Discoloration of the skin leading to its darker and shinier appearance accompanied by shedding of the skin
The appearance of a swollen, pus-filled blister in case of Wet type
Pain in the affected area leading to loss of sensation or numbness and subsequently leading to an inability to move the affected part
Cold when touched
Loss of pulse
A physical examination for diagnosing Gangrene is often followed by tests of tissue, blood, and discharge for getting to know the type of infection. In case of extreme severity, especially when internal organs are involved or if Gangrene seems to be deep-seated, X-Ray, CT scans, and MRIs might be recommended for ascertaining the extent of the disease.
Since Gangrene is associated with tissue necrosis, the only available approach to treatment is the removal of the dead tissue.
Also referred to as debridement, surgical removal of the dead tissue prevents infection from spreading. Sometimes, amputation (severing the affected part) might also be required.
Maggot Therapy is another method which is sometimes followed. Maggots from the larvae of fly bred in sterile conditions in the laboratory are placed on the affected area. They consume for food the dead and infected tissue without causing any harm to healthy tissue.
Intravenous antibiotics help in preventing infection from spreading.
Hyperbaric Oxygen Therapy involves an increase in pressure and oxygen supply to the affected tissue for its healing and to curb infection.
Gangrene, or tissue death, is a life-threatening condition which can be treated through surgery, Maggot therapy, intravenous antibiotics or Hyperbaric Oxygen Therapy.