Factors affecting the outcome of surgically treated non-iatrogenic traumatic cervical esophageal perforation: 28 years experience at a single center

Onat, Serdar; Ülkü, Refık; Cigdem, Kemal M; Avcı, Alper; Özçelik, Cemal

doi:10.1186/1749-8090-5-46

Cited by 46 publications

(47 citation statements)

References 18 publications

(30 reference statements)

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“…As with several previous studies [5,7,8,11,39,] our results were based on a retrospective evaluation of available data. Morbidity and mortality following esophageal perforation are generally high, although varying between series.…”

Section: Discussionmentioning

confidence: 93%

“…Very low annual incidences of between 3–6/1,000,000 were recently published from studies in Iceland [3] and Denmark [4]. Prospective randomized trials with appropriate statistical power are not available due to the rarity of this condition, so the core knowledge is provided from various retrospective institutional [5,6,7,8,9,10,11,12] or community-based series [3,4,13]. Patients with spontaneous perforation of a healthy esophagus (Boerhaave syndrome [14,15]) represent a subgroup of particular concern [16].…”

Section: Introductionmentioning

confidence: 99%

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Esophageal Perforation: Clinical Patterns and Outcomes from a Patient Cohort of Western Norway

Søreide

Sandvik

et al. 2012

Dig Surg

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Background: Esophageal perforation is a rare, often life-threatening condition, and management remains challenging. Methods: Retrospective review of consecutive patients with esophageal perforation treated at two university hospitals between 2000 and 2010. Pertinent data from hospital records were retrieved for statistical calculations and evaluation of perforation score. Results: Forty-seven patients [47% female, median age 62 years (range 15–88)] were included. The annual incidence was 4.7/1,000,000. Perforations were spontaneous in 14 patients (30%), iatrogenic in 25 (53%), and caused by trauma and foreign body impaction in 8 patients (17%). ASA score (p = 0.004), perforation localization (p = 0.001), diagnostic delay (p = 0.002), and perforation score (p < 0.001) differed significantly between patient groups with different etiology, but not between groups with different outcomes. Early diagnosis (≤24 h) was significantly associated with a low perforation score (p = 0.033). A non-operative approach was employed in 26 patients (55%) – more commonly for proximally localized perforations (p = 0.045). The non-operative group showed lower severe complication rates (p = 0.033), shorter ICU stays (p < 0.001) and durations of mechanical ventilation (p = 0.022). The overall 30-day mortality was 23.4%. Conclusion: Careful clinical evaluation and appropriate, individualized treatment are important. The high mortality may be partly explained by the underlying disease and the complexity of the clinical condition in many patients.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Esophageal Perforation: Clinical Patterns and Outcomes from a Patient Cohort of Western Norway

Søreide

Sandvik

et al. 2012

Dig Surg

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“…Fetterman et al [11], reviewed 46 cases of penetrating hypopharyngeal trauma and found an increased morbidity for patients managed conservatively. Similarly, Onat et al [12], reviewed 30 cases of mostly penetrating cervical esophageal injuries and reported increased mortality for patients whose surgery was delayed more than 24 hours.…”

Section: Commentmentioning

confidence: 96%

Management of cervical esophageal and hypopharyngeal perforations

Zenga¹,

Kreisel²,

Kushnir³

et al. 2015

American Journal of Otolaryngology

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“…The thin wall, lack of supporting adventitia, and relatively poor blood supply make the esophagus exceedingly susceptible to perforation . Furthermore, the loose areolar connective tissue and lack of serosa make it unable to prevent the spread of infection and inflammation . This unique anatomical configuration also allows bacteria and digestive enzymes easy access to the mediastinum, leading to mediastinitis, empyema, sepsis, and multi‐organ failure …”

Section: Introductionmentioning

confidence: 99%

Pathogenesis and outcomes of traumatic injuries of the esophagus

et al. 2013

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Background Traumatic injury of the esophagus is extremely uncommon. The aims of this study were to use the Pennsylvania Trauma Outcome Study (PTOS) database to identify clinical factors predictive of esophageal trauma, and to report the morbidity and mortality of this injury. Methods A cross-sectional review of patients presenting to twenty Level I trauma centers in Pennsylvania from 2004 to 2010 was performed. We compared clinical and demographic variables between patients with and without esophageal trauma both prior to, and after arrival in the ER. Primary mechanism of injury and clinical outcomes were analyzed. Results There were 231,694 patients and 327 (0.14%) had esophageal trauma. Patients with esophageal trauma were considerably younger than those without this injury. The risk of esophageal trauma was markedly increased in males [OR= 2.62 (CI 1.98–3.47)]. The risk was also increased in African Americans [OR = 4.61 (CI 3.65–5.82)]. Most cases were from penetrating gunshot and stab wounds. Only 34 (10.4%) of esophageal trauma patients underwent an upper endoscopy; diagnosis was usually made by CT, surgery, or autopsy. Esophageal trauma patients were more likely to require surgery (35.8% vs. 12.5%; p <0.001). Patients with esophageal trauma had a substantially higher mortality than those without the injury (20.5% vs. 1.4%; p <0.005). In logistic regression modeling, traumatic injury of the esophagus [OR=3.43 9 2.50–4.71)] and male gender [OR=1.52 (1.46–1.59)] were independently associated with mortality. For those patients with esophageal trauma, there was an association between trauma severity and mortality [OR = 1.10 (1.07–1.12)] but not for undergoing surgery within the first 24 hours of hospitalization (OR = 0.84; 0.39–1.83). Conclusions Our study on traumatic injury of the esophagus is in concordance with previous studies demonstrating that this injury is rare but carries considerable morbidity (~46%) and mortality (~20%). The injury has a higher morbidity and mortality when the thoracic esophagus is involved compared to the cervical esophagus alone. The injury most commonly occurs in younger, Black males suffering gunshot wounds. Efforts to control gun violence in Pennsylvania are of paramount importance.

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Factors affecting the outcome of surgically treated non-iatrogenic traumatic cervical esophageal perforation: 28 years experience at a single center

Cited by 46 publications

References 18 publications

Esophageal Perforation: Clinical Patterns and Outcomes from a Patient Cohort of Western Norway

Esophageal Perforation: Clinical Patterns and Outcomes from a Patient Cohort of Western Norway

Management of cervical esophageal and hypopharyngeal perforations

Pathogenesis and outcomes of traumatic injuries of the esophagus

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