Nonoperative Management of Esophageal Perforations

Abstract

NOT can be suggested for the treatment of intramural perforations. In the case of transmural perforation, this approach should be taken into consideration if the esophageal lesion is circumscribed, is not in neoplastic tissue, is not in the abdominal cavity, and is not accompanied by simultaneous obstructive esophageal disease; in addition, symptoms and signs of septicemia should be absent.

Management of post dilatation oesophageal perforation: an experience from a tertiary centre

“…Due to poor results in post dilatation malignant perforations, we avoid dilatation and favour feeding jejunostomy for nutrition. Though Iannettoni and associates [2] advocated oesophagectomy even if the stricture is a dilatable corrosive stricture for better functional results, we in our institution are inclined towards preservation of oesophagus except in perforations associated with malignancy According to Orringer et al [13] the approach for oesophagectomy (transthoracic versus transhiatal) is dictated by the chronicity of the perforation, presence and degree of pleural contamination and surgeon experience. We prefer transhiatal resection because postoperative pulmonary complications are minimal, as most of our patients have compromised lung function and nutrition.…”

“…In the present series, use of CT scan with oral contrast resulted in early diagnosis and intervention leading to a mortality as low as 9%. Non-operative management was used in 14 patients who met the criteria of Cameron [11] and Altorjay [2]. Recent, contained perforations in stable patients with minimal signs and symptoms were subjected to non-operative treatment.…”

“…Non-operative management was used in those with minimal septic signs and recent perforation [2]. Pleural collections were drained by chest tubes placement based on computed tomogram.…”

“…Operative management comprised resection, drainage, diversion and primary repair [2,5,6]. The operative procedure was based on aetiology of perforation, its location, size, presence of underlying disease, duration of perforation and the condition of the patient.…”

“…The recommendations vary from non operative management [2] to aggressive surgical management [3]. Moreover, the varied aetiology has led to more individualised treatment.…”