Prognostic factors of esophageal perforation and rupture leading to mortality: a retrospective study

Abstract

Background Esophageal perforation and rupture (EPR) is a serious, potentially life-threatening condition. However, no treatment methods have been established, and data concerning factors affecting mortality are limited. This report presents the prognostic factors of mortality in EPR based on experience in the management of such patients. Methods For this retrospective analysis, 79 patients diagnosed as having EPR between 2006 and 2016 and managed at Gyeongsang National University Hospital were examined. The management method was determined in accordance with the location and size of the EPR, laboratory findings, and radiological findings. Thirty-nine patients were treated with surgery; and 40, with nonsurgical management. Results The most common cause of EPR was foreign body (fish bone or meat bone), followed by vomiting, iatrogenic causes, and trauma. Thirty-nine patients underwent primary repair of EPR, of whom 4 patients died. Forty patients underwent nonsurgical management, of whom 3 patients died. The remaining patients were discharged. Mortality correlated with the size of the EPR (> 25 mm) and the segmented neutrophil count percentage (> 86.5%) in the white blood cell test and differential. Conclusions The mortality risk was increased when the EPR size and the segmented neutrophil count percentage in the white blood cell test and differential was high. Delayed diagnosis, which was considered an important predictive factor in previous investigations, was not statistically significant in this study. Trial registration: Not applicable.

Ingested fish bone causing cervical esophageal perforation with evaluation of critical anatomy by CT: A case report

“…A foreign body causing perforation or rupture of hypopharynx or cervical esophagus reported in the literature includes sharp-edged plastic for medication (Press Through Package) and pointed fish bone [5] . Among 79 cases with esophageal rupture collected in a single institute, 39 sized of rupture > 10 mm underwent primary surgical repair and 4 patients died.…”

“…Among 79 cases with esophageal rupture collected in a single institute, 39 sized of rupture > 10 mm underwent primary surgical repair and 4 patients died. In addition, mortality rate reached to 20% when causes were iatrogenic such as endoscopic procedures [5] , [6] , [7] . The mortality of esophageal perforation or rupture ranges between 10% and 20% unless an optimal treatment is undertaken within 48 hours since the diagnosis.…”

Aetiology, Clinical Manifestations, Diagnosis, and Treatment of Oesophageal Perforation: A Review

“…Timely intervention within 24 hours is generally considered crucial for improved outcomes, with poorer prognosis associated with perforations related to cancer [ 3 ]. Recent studies indicate an overall mortality rate of 20% to 30%, emphasising the strong correlation between the event and intervention [ 4 ]. The anatomy of the oesophagus has been described as a muscular tube originating from the foregut, which functions to transport food and liquids from the oropharynx to the stomach.…”

Esophageal Perforation Etiologies, Management, and Outcomes at a Tertiary Academic Medical Center

“…2 Recent retrospective studies of esophageal perforation report mortality from 10% to 29%. 3-5 A meta-analysis of 2971 patients concluded that cervical perforations have the lowest mortality (5.9%) followed by thoracic (10.9%) and intraabdominal (13.2%) perforations. 6 Clinical manifestations of the perforation depend on etiology, location, severity of contamination, injury of nearby mediastinal structures, and time elapsed from perforation to treatment.…”