Korean J Otorhinolaryngol-Head Neck Surg.  2016 Sep;59(9):668-671. 10.3342/kjorl-hns.2016.59.9.668.

Clinical Analysis and Management of Esophageal Perforation

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
  • 2Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea. mgent.kim@samsumg.com
  • 3Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

Abstract

BACKGROUND AND OBJECTIVES
Esophageal perforation is relatively uncommon and requires careful diagnostic evaluation and expert management. It has a high mortality due to significant mediastinal and pleural contamination leading to sepsis and multiple organ failure. We reviewed our experience of esophageal perforation to determine how to better recognize such a lesion and facilitate its correct management.
SUBJECTS AND METHOD
A retrospective chart review was performed on all patients treated for esophageal perforation from January 2000 to March 2016. These patients have been studied with respect to gender and age distribution, causes, sites, clinical manifestation, complications, management and postoperative complications.
RESULTS
Patients ranged in age from 21 to 87 years, with an average age of 57.6±12.4 years. Fifty of the patients were men and 21 were women. The causes of the perforations were as follows: foreign body retention (18 patients), trauma (17 patients), Boerhaave's syndrome (22 patients), and iatrogenic (14 patients). The sites of esophageal perforation were: the cervical esophagus (25 patients), thoracic esophagus (44 patients) and abdominal esophagus (2 patients). Primary repair only was performed in seven (9.9%) patients, whereas 32 (45%) patients were treated with primary repair & patch, seven (9.9%) patients with T-tube drainage. Exclusion & division were performed in three (4.2%) patients and esophagectomy was performed in two (2.8%) patients. Twenty (28.2%) patients were treated conservatively.
CONCLUSION
Early recognition and appropriate management of esophageal perforation are essential for reduction of morbidity and mortality.

Keyword

Boerhaave's syndrome; Esophageal perforation; Foreign body; Iatrogenic; Trauma

MeSH Terms

Age Distribution
Drainage
Esophageal Perforation*
Esophagectomy
Esophagus
Female
Foreign Bodies
Humans
Male
Methods
Mortality
Multiple Organ Failure
Postoperative Complications
Retrospective Studies
Sepsis
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