Aggressive Surgical Treatment in Late-Diagnosed Esophageal Perforation: A Report of 11 Cases

Abstract

Introduction. Esophageal perforation is a relatively uncommon and lethal disease usually resulting from endoscopic procedures. Delay in the diagnosis and treatment occurs in more than 50% of cases, leading to a mortality rate of 40% to 60%, but this rate decreases is 10%–25% if treatment is carried out within 24 hours of perforation. Case Presentation. To analyze the characteristics, etiology, site of perforation, presentation, time interval till diagnosis, treatment and outcome of patients with esophageal perforation. Over a five-year period, from October 2004 through March 2009, 11 patients with esophageal perforation were referred to the division of thoracic surgery of a tertiary referral hospital. In eight patients, perforations were thoracic with delayed diagnosis for at least 48 hours. Two patients had cervical esophageal perforation, and one patient had early-diagnosed Boerhaave's syndrome. Eight patients are alive after followup for a period ranging from eight months to five years. In the remaining three patients, cancer was the underlying disease and the reason of death. Conclusion. No patient with esophageal perforation should be deprived from surgical repair due to delayed diagnosis. All, except preterminal patients, should undergo exploration after resuscitation, and appropriate treatment should be carried out depending on the findings during operation. Aggressive treatment is necessary in the case of established mediastinitis.

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

“…In recent decades, endoscopic examination of digestive organs and transesophageal echography for cardiovascular disease evaluation have had great impacts on the early detection and improved the outcomes of digestive system and heart diseases [ 14 ]. However, the incidence of iatrogenic esophageal perforation as assessed using endoscopic examinations has also increased in proportion to the incidence of EPR [ 2 , 15 ]. Recent studies have suggested that iatrogenic causes are the most common etiology of EPR [ 16 , 17 ].…”

Prognostic Factors of Esophageal Perforation and Rupture Leading to Mortality: A Retrospective Study

“…In recent decades, endoscopic examination of digestive organs and transesophageal echography for cardiovascular disease evaluation have had great impacts on the early detection and improved the outcomes of digestive system and heart diseases [14]. However, the incidence of iatrogenic esophageal perforation as assessed using endoscopic examinations has also increased in proportion to the incidence of EPR [2,15]. Recent studies have suggested that iatrogenic causes are the most common etiology of EPR [16,17].…”

“…First, it can usually be diagnosed rapidly. The main reason for EPR treatment failure is delayed diagnosis and intervention [15,18]. This is because the symptoms of EPR are usually nonspeci c, such as chest discomfort, orthopnea, fever, and dysphagia [8,19,20,21].…”

Esophageal Perforation in a Patient with Right Aortic Arch and Permanent Pacemaker

“…More than 50% of esophageal perforation were delayed in diagnosis and therapy [5]. The main reason for the delay in diagnosis of this patient is that her neck injury and infection is not obvious.…”