Thirty-four cases of esophageal perforation: the experience of a district general hospital in the UK

Dis Esophagus. 2009;22(7):616-25. doi: 10.1111/j.1442-2050.2009.00959.x. Epub 2009 Mar 17.

Abstract

Esophageal perforation is uncommon and traditionally has a high rate of morbidity and mortality. Our aim was to perform a 13-year retrospective review of the cases managed in our district general hospital. Thirty-four cases of esophageal perforation diagnosed between 1995 and 2008 were retrospectively analyzed. There were 20 males and 14 females with a median age of 64 (range 23-86) years. The etiology of the perforations were Boerhaave's syndrome (n= 19), therapeutic endoscopy (n= 9), diagnostic endoscopy (n= 2), gastric lavage injury (n= 1), foreign body (n= 1), blunt chest trauma (n= 1), and spontaneous tumor perforation (n= 1). Only 11 cases (32%) had evidence of surgical emphysema upon examination. In 50% of cases, another clinical diagnosis was initially suspected. Twenty-four were treated surgically and 10 cases managed non-operatively. Surgical treatment included thoracotomy with primary repair (n= 9), T-tube drainage (n= 7), emergency esophagectomy (n= 1), or intra-operative stent insertion (n= 1). Four cases had primary repair and fundal wrap via abdominal approach without thoracotomy. Two patients were treated with washout and drainage only. Eight patients died overall (in-hospital mortality 23.5%). Esophageal perforations are often initially misdiagnosed and the majority do not have surgical emphysema. There are a wide variety of methods to manage esophageal perforation. Management tailored to the location and size of perforation, degree of contamination, and underlying cause appears to result in a reasonable prognosis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Endoscopy, Gastrointestinal
  • Esophageal Perforation / diagnosis
  • Esophageal Perforation / etiology
  • Esophageal Perforation / surgery*
  • Esophagectomy*
  • Female
  • Hospitals, District
  • Hospitals, General
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Recurrence
  • Retrospective Studies
  • Stents
  • Thoracotomy
  • United Kingdom
  • Young Adult