Management of delayed esophageal perforation with mediastinal sepsis

Salo, Jarmo A.; Isolauri, J; Heikkilä, L; Markkula, H; Heikkinen, Leo O.; Kivilaakso, Eero; Mattila, S

doi:10.1016/s0022-5223(19)33982-0

Cited by 132 publications

(55 citation statements)

References 14 publications

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“…Salo et al stated that mortality of esophagectomy for late esophageal perforation is 13% and mortality of primer repair is 67%. 26 Kiernan et al reported that they successfully treated 20 patients with anastomotic leaks by resection and reconstruction, with a mortality rate of 5%. 31 These studies show that a survey of primary repair is better in sepsis cases with late-presented esophageal perforations.…”

Section: Discussionmentioning

confidence: 99%

“…33 From the literature, the mortality rate is 35-80% for exclusion/ diversion and 13-66% for emergency primary esophagectomy. 26 Although surgical repair is sufficient, the rate of leak is 30%. Additional procedures are necessary in 40% of these patients.…”

Section: Discussionmentioning

confidence: 99%

“…47 Although the morbidity rate is high, it is considerably lower than the morbidity rate associated with operative esophageal repair. 26,48 We used self-expanding metallic stent for perforation resulting from instrumentation in the four cases with esophageal cancer. On the first postoperative day, the patients were allowed oral intake, and no postoperative surgical complication was observed.…”

Section: Discussionmentioning

confidence: 99%

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Current management of esophageal perforation: 20 years experience

Eroğlu

Türkyılmaz

Aydın

et al. 2009

Diseases of the Esophagus

135

100

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Esophageal perforations are surgical emergencies associated with high morbidity and mortality rates. No single strategy has been sufficient to deal with the majority of situations. We aim to postulate a therapeutic algorithm for this complication based on 20 years of experience and also on data from published literature. We performed a retrospective clinical review of 44 patients treated for esophageal perforation at our hospital between January 1989 and May 2008. We reviewed the characteristics of these patients, including age, gender, accompanying diseases, etiology of perforation, diagnosis, location, time interval between perforation and diagnosis, treatment of the perforation, morbidity, hospital mortality, and duration of hospitalization. Perforation occurred in the cervical esophagus in 14 patients (31.8%), thoracic esophagus in 18 patients (40.9%), and abdominal esophagus in 12 patients (27.3%). Management of the esophageal perforation included primary closure in 23 patients (52.3%), resection in 7 patients (15.9%), and nonsurgical therapy in 14 patients (31.8%). In the surgically treated group, the mortality rate was 3 of 30 patients (10%), and 2 of 14 patients (14.3%) in the conservatively managed group. Four of the 14 nonsurgical patients were inserted with covered self-expandable stents. The specific treatment of an esophageal perforation should be selected according to each individual patient. To date, the most effective treatment would appear to be operative management. With improvements in endoscopic procedures, the morbidity and mortality rates of esophageal perforations are significantly decreased. We suggest that minimally invasive techniques for the repair of esophageal perforations will be very important in the future treatment of this condition.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Current management of esophageal perforation: 20 years experience

Eroğlu

Türkyılmaz

Aydın

et al. 2009

Diseases of the Esophagus

135

100

View full text Add to dashboard Cite

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“…Exceptions from primary repair include cervical perforations that cannot be visualized/accessed (see 'drainage only'), diffuse mediastinal necrosis and/or large perforations without the possibility of reapproximation, oesophageal malignancy, endstage benign oesophageal disease (e.g. achalasia), or if the patient is clinically unstable [225][226][227].…”

Section: Diagnosismentioning

confidence: 99%

European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis

Abu‐Omar

Kocher

Bosco

et al. 2017

Eur J Cardiothorac Surg

159

177

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Mediastinitis continues to be an important and life-threatening complication after median sternotomy despite advances in prevention and treatment strategies, with an incidence of 0.25-5%. It can also occur as extension of infection from adjacent structures such as the oesophagus, airways and lungs, or as descending necrotizing infection from the head and neck. In addition, there is a chronic form of 'chronic fibrosing mediastinitis' usually caused by granulomatous infections. In this expert consensus, the evidence for strategies for treatment and prevention of mediatinitis is reviewed in detail aiming at reducing the incidence and optimizing the management of this serious condition.

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“…Primary repair is the treatment of choice within 24 h, but the management of the delayed perforation (more than 24 h) remains controversial. The treatment modalities in the latter group included buttressing of the repair with adjoining autologous tissues including intercostal muscle bundle, pleura, pericardial fat pad, diaphragm, stomach fundus or omendum, 4,6 esophagectomy, 7 exclusion, and diversion followed by delayed reconstruction, 8,9 and T-tube drainage. 10 Several authors 11,12 have claimed that siliconecoated expandable stent is an effective method for the treatment of perforation of intrathoracic esophagus in recent years.…”

Section: Introductionmentioning

confidence: 99%

Management of delayed intrathoracic esophageal perforation with modified intraluminal esophageal stent

Zhou

Gong

Jiang

et al. 2009

Diseases of the Esophagus

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In this article, we reviewed our experience of treatment of the delayed intrathoracic nonmalignant esophageal perforation employing modified intraluminal esophageal stent. Between February 1990 and August 2006, eight patients were included in this study. Five patients experienced sepsis. The interval time between perforation and stent placement ranged from 36 h to 27 days (average, 8.6 days). Esophageal stenting and throracotomy for foreign body removal were performed in four patients. The remaining four patients underwent stent placement and thoracostomy. Nutrition was initiated through gastrostomy after 7 to 10 days after the stenting. The stent was removed after the patients resumed oral intake of food and the esophagogram showed that perforation was closed. There was no death in this group. Signs of sepsis remitted 1 week after stent placement. Complications included stress ulcer, stimulative cough, and pneumonia each. Stent removal ranged 32 to 120 days (average 66.7) after its placement. The stent was kept in place for 4 months to prevent formation of esophageal stricture in one patient with caustic esophageal burns. The follow-up was completed in all the patients. The mean follow-up period was 59 months (range 12-180). One patient with caustic esophageal burn underwent cicatricial esophagectomy and gastric transposition 3 years later due to the esophageal stricture. Barium swallow demonstrated that there was a diverticulum-like outpouching in one patient and slight esophageal stricture at T2 and T3 level in another. One patient developed reflux esophagitis 5 years after stent removal. All the patients finally had a normal intake of food. Modified esophageal stenting is an effective method to manage the delayed intrathoracic esophageal perforation. Prevention of stent migration and its convenient adjustment might be the major advantages of this method.

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Management of delayed esophageal perforation with mediastinal sepsis

Cited by 132 publications

References 14 publications

Current management of esophageal perforation: 20 years experience

Current management of esophageal perforation: 20 years experience

European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis

Management of delayed intrathoracic esophageal perforation with modified intraluminal esophageal stent

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