Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours

Abstract

Esophageal perforation is a rare and potentially life-threatening condition. Early clinical suspicion and imaging is important for case management to achieve a good outcome. However, recent studies continue to report high morbidity and mortality greater than 20% from esophageal perforation. At least half of the perforations are iatrogenic, mostly related to endoscopic instrumentation used in the upper gastrointestinal tract, while about a third are spontaneous perforations. Surgical treatment remains an important option for many patients, but a non-operative approach, with or without use of an endoscopic stent or placement of internal or external drains, should be considered when the clinical situation allows for a less invasive approach. The rarity of this emergency makes it difficult for a physician to obtain extensive individual clinical experience; it is also challenging to obtain firm scientific evidence that informs patient management and clinical decision-making. Improved attention to non-specific symptoms and signs and early diagnosis based on imaging may translate into better outcomes for this group of patients, many of whom are elderly with significant comorbidity.

Conservative management of esophageal perforation due to external air-blast injury: a case report and literature review

“…All of the 11 reported esophageal perforations caused by external air-blast injury presented with pneumothorax or pneumomediastinum. In those patients, flexible endoscopy should be considered to provide additional information [Søreide et al 2011]. In the case presented here, an upper tract GI endoscopy revealed a diagnosis of perforation of the esophagus.…”

“…Esophageal perforation is a life-threatening clinical situation, timely diagnosis is difficult and scientific therapy experiences for this condition are lacking [Søreide and Viste, 2011]. Esophageal perforation caused by iatrogenic or other reasons has been reported frequently, however, barotraumatic injury caused by external air-blast is rare.…”

Boerhaave syndrome - case report

“…1,3,6,10,11 In Boerhaave syndrome, the rupture is transmural, which leads to esophageal perforation. In our patient, hematemesis was the chief complaint.…”

Spontaneous oesophageal perforation in an infant

“…Chest x-rays, water soluble or non-ionic contrast oesophagography and contrast enhanced CT scan with oral contrast are the modalities of choice for early and accurate diagnosis 8 . Surgery is the preferred modality of treatment for haemodynamically unstable patients.…”