Spotlight on esophageal perforation: A multinational study using the Pittsburgh esophageal perforation severity scoring system

Abstract

The Pittsburgh PSS reliably reflects the seriousness of esophageal perforation and stratifies patients into low-, intermediate-, and high-risk groups with differential morbidity and mortality outcomes.

Short- and Long-Term Follow-Up of Patients with Benign Esophageal Perforation

“…The complication rate in our series is substantially higher than previously published data (13,14). Yet, we were able to demonstrate a lower rate of severe complications such as sepsis (15.5%) (13,14). The most common complications in our series were pulmonal complications such as pleural effusion and pneumonia.…”

Development of a Multidisciplinary Program to Expedite Care of Esophageal Emergencies

“…Esophageal perforation as well as other esophageal emergencies remain a challenging assortment of clinical scenarios in which prompt diagnosis and treatment is paramount to successful management. Treatment options for perforation include observation if contained, endoscopic therapy (usually stent placement) if the perforation is of limited size [7][8][9][10][11], or surgical management when a large perforation with gross contamination is present. The basic tenets of surgical management of esophageal perforations include source control of the perforation (either primary repair, which is preferred [12], esophageal resection with concurrent reconstruction, or diversion [13] with drainage.…”

“…The basic tenets of surgical management of esophageal perforations include source control of the perforation (either primary repair, which is preferred [12], esophageal resection with concurrent reconstruction, or diversion [13] with drainage. Authors at the University of Pittsburgh developed a PSS, which was subsequently validated in a separate cohort of patients and found to be predictive of the need for surgical management as well as of mortality [6,11]. A PSS of greater than 5 is predictive of a greater than 3-fold increase in the need for surgical management and carries a 27% risk of death; a PSS of greater than 9 carries 0% survival.…”

Multistage treatment of a patient with spontaneous rupture of the esophagus in a multidisciplinary hospital setting

“…Наиболее часто разрыв локализуется в нижней трети пищевода по его левой стенке [4]. Клинические проявления данного заболевания неспецифичны, диагностика часто затягивается (более 12 ч) [3]. Кроме того, в настоящее время нет единых подходов к ведению данных пациентов с учетом возраста, времени, которое прошло от момента разрыва пищевода, степени выраженности системной воспалительной реакции [2,3].…”

“…Клинические проявления данного заболевания неспецифичны, диагностика часто затягивается (более 12 ч) [3]. Кроме того, в настоящее время нет единых подходов к ведению данных пациентов с учетом возраста, времени, которое прошло от момента разрыва пищевода, степени выраженности системной воспалительной реакции [2,3]. Приводим клиническое наблюдение многоэтапного успешного лечения возрастной пациентки со спонтанным разрывом правой стенки пищевода в его средней трети.…”