Esophageal Perforation

Sawyers, John L.; Lane, Carl E.; Foster, John; Daniel, Rollin A.

doi:10.1016/s0003-4975(10)64010-6

Cited by 76 publications

(6 citation statements)

References 6 publications

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“…4,35 Table 1 lists symptoms and signs of CEPs. 4,24,33,35,36,54,55 The early signs of CEPs on physical examination are cervical tenderness, regurgitation of bloody material, dysphonia, dysphagia, and cervical subcutaneous emphysema (occurring in 22%-24.6% of cases). 4,31,35 Late signs of CEPs include fever (occurring in 51%-73.1% of cases) and inflammatory changes in the neck, such as erythema (occurring in 30.8% of cases).…”

Section: Clinical Presentationmentioning

confidence: 99%

Management of Iatrogenic Cervical Esophageal Perforations

Chen

Shapira‐Galitz

Garber

et al. 2020

JAMA Otolaryngol Head Neck Surg

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sophageal perforation is a rare but life-threatening condition that is difficult to diagnose and treat, with an incidence of 3.1 cases per 1 000 000 per year. 1 It has an overall mortality rate of 13.3%, but this percentage varies from 4% to 80% depending on the type of perforation and the time to diagnosis. 2 Discrepancies in the diagnosis and management of esophageal perforations also contribute to the wide range of mortality rates. The most common causes of esophageal perforation are iatrogenic (46.5%), spontaneous (37.8%), foreign body (6.3%), corrosive (1.8%), and traumatic (<1%). 2,3 Overall, 72.6% of esophageal perforations are thoracic, 15.2% are cervical, and 12.5% are abdominal. 2 Cervical esophageal perforations (CEPs) have a mortality rate of 6% to 8%, [4][5][6][7] which is the lowest mortality rate for esophageal perforations. However, there is little existing literature that focuses specifically on cervical perforations. A 10-year cross-sectional study 4 of CEPs found them to be due to iatrogenic injury (58%), foreign body ingestion (27%), and penetrating injury (15%). Iatrogenic CEPs (iCEPs) are unique among CEPs for various reasons. The increased frequency of endoscopy for diagnosis and treatment has led to a rising number of iatrogenic esophageal injuries. 8 In addition, the management of iCEPs is controversial and lacking in evidence. Conservative management includes antibiotics and feeding tube placement, but cervical drainage is also frequently added to this treatment regimen. More aggressive surgical approaches to treatment, such as pri-

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Section: Clinical Presentationmentioning

confidence: 99%

Management of Iatrogenic Cervical Esophageal Perforations

Chen

Shapira‐Galitz

Garber

et al. 2020

JAMA Otolaryngol Head Neck Surg

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“…Sawyers et al (1975) found that the mortality increased fourfold when treatment was delayed for longer than 24 hours.…”

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confidence: 99%

A conservative approach in selected cases of late diagnosed oesophageal perforation.

Verwoerd¹,

Mazijk²,

Meyer³

1977

Thorax

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. (1977). Thorax, 32,[232][233][234]. A conservative approach in selected cases of late diagnosed oesophageal perforation. A conservative method is presented for the treatment of oesophageal perforation where the diagnosis has been delayed. A system of tubes is described which allows the patient to be fed and at the same time prevents swallowed material from reaching the fistula. A case is reported which was successfully managed using the method.

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“…Wir bevorzugen deshalb bei allen nicht malignen Oesophagusperforationen das operative Vorgehen, mit -falls m6glich -direkter Naht der Perforation, selbst wenn die Verletzung langere Zeit zuriickliegt [15]. Sandrasaga et al [17] und Sawyers et al [18] fanden nach intrathorakaler oder intraabdomineller Speiser6hrenverletzung eine dreimal h6here Letalit/it als bei cervicalen Oesophagusleckagen. Immer wenn m6glich, sollten Verfahren mit zusatzlicher Serosaabdichtung des Nahtbereiches z.B.…”

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“…Diese L/isionen sind gew6hnlich im intraabdominellen Oesophagusabschnitt lokalisiert und entstehen haupts/ichlich bei Vagotomie oder Hiatushernienoperationen [18]. Diese L/isionen sind gew6hnlich im intraabdominellen Oesophagusabschnitt lokalisiert und entstehen haupts/ichlich bei Vagotomie oder Hiatushernienoperationen [18].…”

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Spontane und andere nicht tumorbedingte Oesophagusperforationen

Keller

Müller

Pichlmaier

1987

Langenbecks Arch Chiv

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The outcome of esophageal perforation is determined by the cause and localisation, but mainly by the time lapse between trauma and therapy. Spontaneous and intraoperative ruptures are most dangerous. Treatment of choice is direct closure and drainage. If this is not possible, esophagectomy or exclusion and diversion in continuity should be considered. The injury may present itself with rather unspecific symptoms. Pathological findings in the plain chest roentgenogram and gastrographin study will confirm diagnosis in nearly all cases.

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Esophageal Perforation

Cited by 76 publications

References 6 publications

Management of Iatrogenic Cervical Esophageal Perforations

Management of Iatrogenic Cervical Esophageal Perforations

A conservative approach in selected cases of late diagnosed oesophageal perforation.

Spontane und andere nicht tumorbedingte Oesophagusperforationen

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