Management of Esophageal Perforation in Adults

Abstract

Perforation of esophagus in the adult is a very morbid condition with high morbidity and mortality. The ideal treatment is controversial. The main causes for esophageal perforation in adults are iatrogenic, traumatic, spontaneous and foreign bodies. The morbidity and mortality rate is directly related to the delay in diagnosis and initiation of optimum treatment. The reported mortality from treated esophageal perforation is 10% to 25%, when therapy is initiated within 24 hours of perforation, but it could rise up to 40% to 60% when the treatment is delayed beyond 48 hours. Primary closure of the perforation site and wide drainage of the mediastinum is recommended if perforation is detected in less than 24 hours. Treatment option for delayed or missed rupture of esophagus is not very clear and is controversial. Recently a substantial number of patients with esophageal perforation are being managed by nonoperative measures. Patients with small perforations and minimal extraesophageal involvement may be better managed by nonoperative treatment Major prognostic factors determining mortality are the etiology and site of the injury, the presence of underlying esophageal pathology, the delay in diagnosis and the method of treatment. For optimum outcome for management of esophageal perforations in adults a multidisciplinary approach is needed.

Penetrating Neck Trauma in Children Causing Complex Digestive Tract Injury: A Case Report

“…These perforations are: (i) more often iatrogenic (ii) more likely to occur within the cervical esophagus, and (iii) not generally associated with an underlying malignancy. Chest pain, fever, tachypnea, and/or tachycardia with subcutaneous emphysema are common features which were found in our case too [6].…”

Esophageal Rupture Due to Diving in Shallow Waters

“…Manifestations of esophageal rupture include pain, vomiting, hematemesis, dysphagia, odynophagia, dysphonia, dyspnea, and/or fever [5]. In our particular case the most common symptom of pain was not possible to evaluate due to his quadriplegic condition.…”

“…The choice of management of esophageal rupture in this particular case was very difficult. Nonoperative management has a mortality of 20-38% and a surgical alternative in a patient with late diagnosis of over 24 hours is 27% [5]. In patients with esophageal rupture diagnosed more than 48 hours after the incident where there is significant mediastinitis, an esophageal diversion and gastrostomy operation would be indicated.…”

Penetrating neck trauma in children causing aerodigestive tract injury: A case presentation

“…Consensus regarding the appropriate management of this lifethreatening condition is lacking [7]. The reported mortality from treated esophageal perforation is 10-25%, when therapy is initiated within 24 hours of perforation and it is 40-60% when the treatment is delayed.…”

“…The reported mortality from treated esophageal perforation is 10-25%, when therapy is initiated within 24 hours of perforation and it is 40-60% when the treatment is delayed. The reason for this multifold increase in mortality is due to the unique anatomical configuration and location of the esophagus, which allows bacteria and digestive enzymes easy access to the mediastinum, leading to the development of severe mediastinitis, empyema, sepsis, and multiple organ dysfunction syndromes [7]. After immediate resuscitations and multisystem support, the child was taken to the operating room for cervical esophageal exploration.…”