Clinical analysis of the diagnosis and treatment of esophageal perforation

Okumura, Hiroshi; Uchikado, Yasuto; Kita, Yoshiaki; Omoto, Itaru; Hayashi, Naoki; Matsumoto, Masataka; Sasaki, Ken; Setoyama, Tetsuro; Arigami, Takaaki; Uenosono, Yoshikazu; Matsushita, Daisuke; Desaki, Ryosuke; Noda, Masahiro; Higo, Naotomo; Okubo, Kan; Urata, Masakazu; Yamasaki, Yoichi; Owaki, Tetsuhiro; Ishigami, Sumiya; Natsugoe, Shoji

doi:10.1007/s10388-015-0504-6

Cited by 2 publications

(5 citation statements)

References 19 publications

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“…method might be chosen based on etiology, size or location of perforation, complications related to the mediastinum, or systemic condition of each patient. [3,6,11,24] However, surgical and non-surgical strategies have no superiority to each other, as seen both in the literature and our study. We think that the variable outcomes in the literature depend on patient selection.…”

Section: Treatment Optionssupporting

confidence: 66%

“…The Pittsburgh Perforation Severity Scores (PSSs) of all patients were calculated according to the study by Abbas et al Patients were rated as follows: 1 point for age >75 years, tachycardia (>100 bpm), leukocytosis (>10,000 WBC/mL), and pleural effusion (on chest X-ray, CT, or barium swallow); 2 points for fever (>38.5 °C), uncontained leak (on barium swallow or CT), respiratory compromise (respiratory rate >30, increasing oxygen requirement, or need for mechanical ventilation), and time to diagnosis >24 h; and three points for presence of cancer and hypotension. With reference to that, patients were divided into three groups as low PSS (≤2), intermediate PSS (3)(4)(5), and high PSS (>5). The initial treatment was categorized as operative or non-operative management that included conservative observation, endoscopic stenting, and surgical drainage.…”

Section: Methodsmentioning

confidence: 99%

“…[1,2] The most common cause of death in patients with EP is sepsis, which leads to multiorgan failure. [3] The esophagus has no serosal surface; thus, thoracic perforations could cause dissemination of the surrounding tissues and lead to mediastinitis. EP monitoring and support and antibiotic therapy should be initiated.…”

Section: Introductionmentioning

confidence: 99%

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A 4-year single-center experience in management of esophageal perforation

Sarı¹

2018

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Esophageal perforation (EP) is a lethal surgical emergency that needs to be diagnosed and treated immediately. Diagnosis and treatment options for EP are limited due to its lower incidence. There are scoring systems proposed for this purpose; however, they cannot be applied to every patient. The recent trend in the treatment of EP is toward the non-operative approach over the surgical treatment methods. The purpose of the present study was to evaluate our treatment methods and outcomes in patients with EP. METHODS: Thirteen patients with EP treated in our clinic between 2013 and 2017 were retrospectively reviewed. The Pittsburgh Perforation Severity Score (PSS), systemic condition status, and Clavien-Dindo Classification (CDC) score were assessed, and treatment methods were reviewed. Their effects on morbidity and mortality were examined using Fisher's exact test and biserial correlation test. RESULTS: A total of 13 patients (six males and seven females; median age 64 years) were included in the study. Ten patients were managed non-operative, and three were treated surgically. Of the 10 patients, two had additional surgery after non-operative management. The PSS, systemic condition status, CDC score, duration of stay in the hospital, time to diagnosis, presence of hypotension, and being in shock were strongly correlated with mortality (p<0.05). The PSS, CDC score, and stay in the intensive care unit were strongly correlated with morbidity (p<0.05). The comparison between the non-operative and operative groups did not yield a statistically significant difference in mortality and morbidity. CONCLUSION: Even if the scoring systems help to understand the severity of the condition, they are inadequate to determine the treatment option. Early diagnosis and treatment are the most important steps in management. Operative and non-operative treatment options are not superior to each other, but their complementary use will be more beneficial for the patients.

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Section: Treatment Optionssupporting

confidence: 66%

Section: Methodsmentioning

confidence: 99%

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A 4-year single-center experience in management of esophageal perforation

Sarı¹

2018

Ulus Travma Acil Cerrahi Derg

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“…We treated 13 esophageal perforation cases from 2004 to 2019; among these, there were 4 cases, including this case, involving septic shock. We performed conservative treatment with esophageal stents, and we rescued all patients while avoiding surgical procedures [7]. Conservative treatment using esophageal stents with a check valve is effective in critically ill patients, but the further supporting evidence from additional cases is necessary for verification.…”

Section: Discussionmentioning

confidence: 99%

“…While surgical treatment, such as primary repair or debridement, has been employed for esophageal perforation [5], conservative treatment is limited to patients with a disruption in the mediastinum or between the mediastinum and visceral lung pleura, drainage of the cavity back into the esophagus, minimal symptoms, and minimal signs of clinical sepsis [6]. We have adopted conservative treatment with a temporary self-expanding silicon-covered stent rather than surgical treatment for patients in a poor physical condition because we consider controlling sepsis and improving the physical status are the highest priorities; additionally, the surgical trauma could be fatal for these patients [7]. Here, we present a case of spontaneous intrathoracic esophageal perforation with septic shock successfully treated conservatively with a temporary self-expanding silicon-covered stent with a check valve, sufficient drainage, and W-ED tube nutrition.…”

Section: Introductionmentioning

confidence: 99%

Successful conservative treatment of spontaneous intrathoracic esophageal perforation using a temporary covered esophageal stent with a check valve: a case report

et al. 2019

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BackgroundSpontaneous esophageal perforation is a potentially life-threatening condition with high morbidity and mortality rates. While surgical treatment has been employed for esophageal perforation, we have adopted conservative treatment with an esophageal stent for patients in a poor physical condition because we consider controlling sepsis and improving the physical status are the highest priorities; additionally, the surgical trauma could be fatal for these patients.Case presentationA 60-year-old male complaining of left chest and back pain after vomiting was transferred to a local hospital. Computed tomography and chest X-ray examinations showed left tension pneumothorax, pneumomediastinum, and bilateral pleural effusion suspicious of spontaneous intrathoracic esophageal perforation. He was transferred to our hospital for further treatment. After arrival, he developed septic shock with acute respiratory failure. We considered that surgical treatment was too invasive and chose conservative treatment with an esophageal stent. Under general anesthesia, we first inserted a 20-Fr. trocar in the left posterior pleural space, and a large volume of the dark pleural effusion was discharged. We then performed endoscopy and found a pinhole perforation in the left posterolateral wall of the lower esophagus. We inserted both a silicon-covered esophageal stent with a check valve and a double elemental diet (W-ED) tube. We then inserted an 18-Fr. trocar into the left anterior wall. These procedures were performed less than 24 h after onset. As intensive medical care, the patient was administered broad-spectrum antibiotics and catecholamine. The two trocars and the W-ED tube were under continuous suction at − 5 cmH2O and at − 20 cmH2O every 30 s. On the 6th day, we inserted an additional thoracic drainage tube into the left pleura under CT guidance. The patient was discharged from the ICU to the general ward on the 7th day. We removed the stent almost triweekly, and the esophageal perforation was completely healed on the 45th day. He was discharged home on the 70th day.ConclusionConservative treatment with a temporary self-expanding covered stent with a check valve, sufficient drainage, and W-ED tube nutrition was useful and effective in this unstable case of spontaneous intrathoracic esophageal perforation.

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Clinical analysis of the diagnosis and treatment of esophageal perforation

Cited by 2 publications

References 19 publications

A 4-year single-center experience in management of esophageal perforation

A 4-year single-center experience in management of esophageal perforation

Successful conservative treatment of spontaneous intrathoracic esophageal perforation using a temporary covered esophageal stent with a check valve: a case report

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