Perforation and Rupture of the Esophagus

Abstract

A series of 57 esophageal perforations from the period 1963-1982 is reported. They comprised 42 iatrogenic, instrumental perforations and 15 non-iatrogenic, mainly spontaneous and postemetic ruptures. The clinical manifestations were mostly pain, fever, subcutaneous and mediastinal emphysema, pleural effusion and pneumothorax. Esophageal leak was demonstrated in 73% of contrast studies. The overall mortality rate was 25%. It was 21% in cases with primary suture closure and 50% when treatment consisted of drainage. The mortality rate was 19% when treatment was begun within 24 hours and 35% when there was longer delay. Other factors influencing the mortality rate seemed to be type and location of the perforation and age of the patient. Early surgical intervention is advocated for perforation or rupture of the intrathoracic esophagus. Data in the literature and our own findings indicate that also in cervical esophageal perforations early surgical repair is justifiable.

Adverse events of upper GI endoscopy

“…61 Pain is the most common symptom related to perforation. 25,26,62,63 Fever, crepitus, pleuritic chest pain, leukocytosis, and pleural effusion may also be present. Perforation with associated air dissection may be diagnosed by plain radiography of the neck and/or chest, but such findings may be absent immediately after perforation.…”

Spontaneous Esophageal Rupture

“…Some reports state that, after 24 h of the rupture, the esophageal wall in the region of the lesion is too inflamed and fragile for primary closure, and only careful pleural drainage should be done [1,6,19]. Like some other authors, we have treated with success esophageal ruptures by primary-suture closure also more than 24 h after the rupture [12,[20][21][22], However, the mortality rises significantly when the treat ment has delayed more than 48 h. The treat ment results of our series demonstrate clearly that the most important factors for reducing mortality and morbidity are early diagnosis and immediate primary-suture closure of the esophageal rupture.…”

Spontaneous Oesophageal Perforation With Simultaneous Perforated Duodenal Ulcer

“…4 The previous case report of the dual pathologies involved a 36-year-old man with a 2-week history of fevers, chills, shortness of breath and right-sided pleuritic pain. At operation a left-sided distal oesophageal perforation and a perforated posterolateral duodenal ulcer tracking into the lesser sac was discovered.…”