Thirty-four cases of esophageal perforation: the experience of a district general hospital in the UK.

Abstract

Esophageal perforation is uncommon and traditionally has a high rate of morbidity and mortality. Our aim was to perform a 13-year retrospective review of the cases managed in our district general hospital. Thirty-four cases of esophageal perforation diagnosed between 1995 and 2008 were retrospectively analyzed. There were 20 males and 14 females with a median age of 64 (range 23-86) years. The etiology of the perforations were Boerhaave's syndrome (n= 19), therapeutic endoscopy (n= 9), diagnostic endoscopy (n= 2), gastric lavage injury (n= 1), foreign body (n= 1), blunt chest trauma (n= 1), and spontaneous tumor perforation (n= 1). Only 11 cases (32%) had evidence of surgical emphysema upon examination. In 50% of cases, another clinical diagnosis was initially suspected. Twenty-four were treated surgically and 10 cases managed non-operatively. Surgical treatment included thoracotomy with primary repair (n= 9), T-tube drainage (n= 7), emergency esophagectomy (n= 1), or intra-operative stent insertion (n= 1). Four cases had primary repair and fundal wrap via abdominal approach without thoracotomy. Two patients were treated with washout and drainage only. Eight patients died overall (in-hospital mortality 23.5%). Esophageal perforations are often initially misdiagnosed and the majority do not have surgical emphysema. There are a wide variety of methods to manage esophageal perforation. Management tailored to the location and size of perforation, degree of contamination, and underlying cause appears to result in a reasonable prognosis.

• Authors: E A Griffiths, N Yap, J Poulter, M T Hendrickse, M Khurshid
• Journal: Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus (Dis Esophagus) Vol. 22 Issue 7 Pg. 616-25 ( 2009) ISSN: 1442-2050 [Electronic] United States
• PMID: 19302220 (Publication Type: Case Reports, Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Endoscopy, Gastrointestinal
• Esophageal Perforation (diagnosis, etiology, surgery)
• Esophagectomy
• Female
• Hospitals, District
• Hospitals, General
• Humans
• Male
• Middle Aged
• Prognosis
• Recurrence
• Retrospective Studies
• Stents
• Thoracotomy
• United Kingdom
• Young Adult