Management of esophageal perforation in 120 consecutive patients: clinical impact of a structured treatment algorithm.

Abstract

INTRODUCTION:

The therapy of esophageal perforation is still challenging. The aim of this study was to assess the etiology, specific treatment, and outcome of esophageal disruption in order to generate an optimal therapeutic approach to improve patient's outcome.

METHODS:

We reviewed the cases of 120 consecutive patients with esophageal perforation treated within 10 years.

RESULTS:

Iatrogenic perforation was the most frequent cause of esophageal perforation (58.3 %); Boerhaave's syndrome was detected in 15 cases (6.8 %). Surgery was performed in 66 patients (55 %), 17 (14 %) patients received conservative treatment and 37 (31 %) patients underwent endoscopic stenting after tumorous perforation. Statistically significant impact on mean survival had Boerhaave's syndrome (p = 0.005), initial sepsis (p = 0.002), pleural effusion/empyema (p = 0.001), mediastinitis (p = 0.003), peritonitis (p = 0.001), and redo-surgery (p = 0.000). Overall mortality rate was 11.7 %, in the esophagectomy group 17 % and in the patients with Boerhaave's syndrome 33.3 %.

CONCLUSIONS:

An approach considering etiology and extent of perforation, diagnostic delay, and septic status is required to improve patient's outcome. Primary repair is feasible in patients without intrinsic esophageal disease and evidence of sepsis. The greater the diagnostic delay, the more the destruction of the esophageal wall especially in the case of septic esophageal disease, thus the stronger the argument for esophagectomy if anatomically and/or oncologically possible.

• Authors: Joerg Lindenmann, Veronika Matzi, Nicole Neuboeck, Udo Anegg, Alfred Maier, Josef Smolle, Freyja Maria Smolle-Juettner
• Journal: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (J Gastrointest Surg) Vol. 17 Issue 6 Pg. 1036-43 (Jun 2013) ISSN: 1873-4626 [Electronic] United States
• PMID: 23558714 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Algorithms
• Esophageal Perforation (complications, etiology, therapy)
• Esophagectomy (adverse effects)
• Esophagoscopy (adverse effects)
• Female
• Humans
• Iatrogenic Disease
• Length of Stay
• Male
• Mediastinal Diseases (therapy)
• Middle Aged
• Retrospective Studies
• Sepsis (etiology)
• Stents
• Survival Analysis
• Time Factors
• Young Adult