Management of esophageal perforations

Schmidt, Sven; Strauch, Stefan; Rösch, Thomas; Veltzke‐Schlieker, Wilfried; Jonas, Sven; Pratschke, Johann; Weidemann, H.; Neuhaus, P.; Schumacher, Guido

doi:10.1007/s00464-010-1054-6

Cited by 70 publications

(41 citation statements)

References 18 publications

(24 reference statements)

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“…Etiology and treatment are summarized in Table 1. The mean hospital stay was 9.3 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) days in the early presented and 68.3 (16-300) days in the delayed presented group.…”

Section: Resultsmentioning

confidence: 99%

“…The objectives of treatment include prevention of further contamination from the perforation, elimination of infection, restoration of the integrity of the gastrointestinal tract, and establishment of nutritional support. Therefore, debridement of infected and necrotic tissue, meticulous closure of the perforation, total elimination of distal obstruction, and drainage of contamination are essential to successful management [14]. Esophagectomy provides the best treatment option, when concomitant obstructive stricture is present, or when attempted drainage, closure, or exclusion has failed to control local infection, necrosis, and sepsis.…”

Section: Early Presentation <24hmentioning

confidence: 99%

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Treatment of Early and Delayed Esophageal Perforation

et al. 2012

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Esophageal perforations are life threatening emergencies associated with high morbidity and mortality. We report on 22 consecutive patients (age 20-86; 13 female and 9 male) with an oesophageal perforation treated at the university hospital Duesseldorf. The patients' charts were reviewed and follow-up was completed for all patients until demission, healed reconstruction or death. Patients' history, clinical presentation, time interval to surgical presentation, and treatment modality were recorded and correlated with patients' outcome. Six esophageal perforations were due to a Boerhaave-syndrome, eleven caused by endoscopic perforation, two after osteosynthesis of the cervical spine and three foreign body induced. In 7 patients a primary local suture was performed, in 4 cases a supplemental muscle flap was interposed, and 7 patients underwent an oesophageal resection. Four patients were treated without surgery (three esophageal stent implantations, one conservative treatment). Eleven patients (50 %) were presented within 24 h of perforation, and 11 patients (50 %) afterwards. Time delay correlates with survival. In 17 (80.9 %) cases a surgical sufficient reconstruction could be achieved. One (4.7 %) patient is waiting for reconstruction after esophagectomy. Four (18.2 %) patients died. A small subset of patients can be treated conservatively by stenting of the Esophagus, if the patient presents early. In the majority of patients a primary repair (muscle flap etc.) can be performed with good prognosis. If the patient presents delayed with extensive necrosis or mediastinitis, oesophagectomy and secondary repair is the only treatment option with high mortality.

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Section: Resultsmentioning

confidence: 99%

Section: Early Presentation <24hmentioning

confidence: 99%

Treatment of Early and Delayed Esophageal Perforation

et al. 2012

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“…But a review of the literature did not reveal its association of with oesophagocutaneous fistula following thyroid surgeries [3,5]. However in the index case, the finding of gastric heterotopia seems to be coincidental.…”

mentioning

confidence: 99%

“…A single layer primary anastomosis was done (with polyglycolic acid resection. The outcome of conservative management has a better prognosis in injuries recognised early and in cervical oesophageal injury [3,4]. In the index case the injury was not recognised early which probably led to the formation of stricture at the site of injury causing oesophageal luminal obstruction and fistula.…”

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confidence: 99%