Endoscopic perforations of the upper digestive tract: A review of their pathogenesis, prevention, and management

Pasricha, Pankaj J.; Fleischer, David E.; Kalloo, Anthony N.

doi:10.1016/0016-5085(94)90717-x

Cited by 125 publications

(89 citation statements)

References 102 publications

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“…Contrast swallow studies may help in confirmation and localization of the perforation, showing an extravasation of fluid from the viscerum and/or an airfluid collection in deep neck spaces [3]. Esophagoscopy can provide a direct visualization of the perforation, but a missed perforation hidden in a mucosal fold and the potential to convert a small mucosal or submucosal tear into a large perforation during air insufflation argue against its use [27]. CT or MRI can delineate the extent of infection and reveal ncurrent discitis, osteomyelitis, epidural abscess, or mediastinitis.…”

Section: Discussionmentioning

confidence: 99%

Esophagus perforation complicating anterior cervical spine surgery

Lü

Guo

2011

Eur Spine J

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Purpose To study the diagnosis and treatment strategy of esophagus perforation complicating anterior cervical spine surgery.Methods From 2000 to 2010, we performed 1,045 cases of anterior cervical surgeries. One developed esophagus perforation. The diagnosis and treatment strategy of this case and the other five patients with esophagus perforation from other hospitals were retrospectively reviewed. For an intraoperative perforation, primary double layer suture was performed. Postoperatively, the patient took nutrition by a nasogastric tube instead of oral intake for one week. For three cases of perforations early in the post-operative period, oral intake was forbidden and nasogastric tube was conducted for nutrition support. The wound was debrided and open drainage was conducted postoperatively. Intravenous broad-spectrum antibiotic therapy was utilized. For perforations at postoperative year 3 and 7, prohibition of oral intake, intravenous broad-spectrum antibiotics therapy, and nasogastric tube nutrition support were all conducted and surgical debridement was performed. In operation, fixation plates and screws were removed, and the edges of the perforation were loosely approximated by synthetic absorbable sutures. Postoperatively, skin wound was kept open for drainage.Results All the perforations healed evenly without secondary complications. Conclusions When a perforation is suspected, imaging techniques should be employed. Surgical treatment facilitates the healing of esophagus perforation. Supportive treatments including prohibition of oral intake, intravenous broad-spectrum antibiotic therapy, feeding with a nasogastric tube were mandatory parts of treatments.

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Section: Discussionmentioning

confidence: 99%

Esophagus perforation complicating anterior cervical spine surgery

Lü

Guo

2011

Eur Spine J

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“…[1][2][3][4][5][6] Typical structure and placement of esophagus leads to infection by bacteria easily as well as damage by digestive enzymes can occur which in turn can lead to increased mortality. 7 But fortunately this condition of esophageal perforation is rare. Its presentation is also not typical in all the cases.…”

Section: Introductionmentioning

confidence: 99%

“…In adult cases of esophageal perforation, the important causes can be due to trauma, or due to foreign body or due to iatrogenic and sometimes it may be spontaneous. [7][8][9][10] In case the diagnosis of perforation is made within 24 hours, the treatment of choice is primary closure of the perforation site and wide drainage of the mediastinum. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] On the other hand, if the diagnosis is delayed for more than 24 hours, then the treatment of choice is questionable.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9][10] In case the diagnosis of perforation is made within 24 hours, the treatment of choice is primary closure of the perforation site and wide drainage of the mediastinum. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] On the other hand, if the diagnosis is delayed for more than 24 hours, then the treatment of choice is questionable. [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Mortality rate is determined by some factors like cause, the injury site, pre-existing disease of esophagus, treatment method used and the timing of the diagnosis.…”

Section: Introductionmentioning

confidence: 99%

“…[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Mortality rate is determined by some factors like cause, the injury site, pre-existing disease of esophagus, treatment method used and the timing of the diagnosis. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Esophageal perforations are dramatic complications and if managed improperly result in mortality. Proper management requires an appreciation of the anatomy, the etiology and the pathophysiology of this entity.…”

Section: Introductionmentioning

confidence: 99%

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Approach and management modalities in Esophageal Perforations

et al. 2018

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Esophageal perforation leads to increased morbidity and mortality. Treatment of choice is debatable. In adult cases of esophageal perforation, the important causes can be due to trauma, or due to foreign body or due to iatrogenic and sometimes it may be spontaneous. The rate of morbidity and mortality is increased among those who fall prey to delayed diagnosis and delayed treatment. Even after the proper treatment started within one day of diagnosis, the death rate can be 10-25%. And it increases to 40-60% among those who receive treatment after two days. In case the diagnosis of perforation is made within 24 hours, the treatment of choice is “primary closure of the perforation site and wide drainage of the mediastinum”. On the other hand, if the diagnosis is delayed for more than 24 hours, then the treatment of choice is questionable. Now a days conservative method of management is more or less adopted especially patients with small size perforation and minimum involvement of extra esophageal part. Mortality rate is determined by some factors like cause, the injury site, pre-existing disease of esophagus, treatment method used and the timing of the diagnosis. Hence multi-disciplinary approach is recommended for proper outcome. Timing of intervention is extremely critical in ensuring low mortality. Diagnosis is difficult, and a high degree of suspicion is required, especially in pediatric patients. As Endoscopic therapists play an increasingly “important role in the management of upper digestive disease”, a proper understanding of this complication of therapy is required by the therapist and the attending surgeons. Management of such perforations are both non-operative and operative. Nonoperative management used for limited perforations without sepsis, while operative management is reserved for more florid perforations and those in whom obstruction distal to the perforation exists. Endoscopic intervention may save some patients from being operated upon.

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Management of Iatrogenic Cervical Esophageal Perforations

Chen

Shapira‐Galitz

Garber

et al. 2020

JAMA Otolaryngol Head Neck Surg

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sophageal perforation is a rare but life-threatening condition that is difficult to diagnose and treat, with an incidence of 3.1 cases per 1 000 000 per year. 1 It has an overall mortality rate of 13.3%, but this percentage varies from 4% to 80% depending on the type of perforation and the time to diagnosis. 2 Discrepancies in the diagnosis and management of esophageal perforations also contribute to the wide range of mortality rates. The most common causes of esophageal perforation are iatrogenic (46.5%), spontaneous (37.8%), foreign body (6.3%), corrosive (1.8%), and traumatic (<1%). 2,3 Overall, 72.6% of esophageal perforations are thoracic, 15.2% are cervical, and 12.5% are abdominal. 2 Cervical esophageal perforations (CEPs) have a mortality rate of 6% to 8%, [4][5][6][7] which is the lowest mortality rate for esophageal perforations. However, there is little existing literature that focuses specifically on cervical perforations. A 10-year cross-sectional study 4 of CEPs found them to be due to iatrogenic injury (58%), foreign body ingestion (27%), and penetrating injury (15%). Iatrogenic CEPs (iCEPs) are unique among CEPs for various reasons. The increased frequency of endoscopy for diagnosis and treatment has led to a rising number of iatrogenic esophageal injuries. 8 In addition, the management of iCEPs is controversial and lacking in evidence. Conservative management includes antibiotics and feeding tube placement, but cervical drainage is also frequently added to this treatment regimen. More aggressive surgical approaches to treatment, such as pri-

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Endoscopic perforations of the upper digestive tract: A review of their pathogenesis, prevention, and management

Cited by 125 publications

References 102 publications

Esophagus perforation complicating anterior cervical spine surgery

Esophagus perforation complicating anterior cervical spine surgery

Approach and management modalities in Esophageal Perforations

Management of Iatrogenic Cervical Esophageal Perforations

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