Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours

Scand J Trauma Resusc Emerg Med. 2011 Oct 30;19:66. doi: 10.1186/1757-7241-19-66.

Abstract

Esophageal perforation is a rare and potentially life-threatening condition. Early clinical suspicion and imaging is important for case management to achieve a good outcome. However, recent studies continue to report high morbidity and mortality greater than 20% from esophageal perforation. At least half of the perforations are iatrogenic, mostly related to endoscopic instrumentation used in the upper gastrointestinal tract, while about a third are spontaneous perforations. Surgical treatment remains an important option for many patients, but a non-operative approach, with or without use of an endoscopic stent or placement of internal or external drains, should be considered when the clinical situation allows for a less invasive approach. The rarity of this emergency makes it difficult for a physician to obtain extensive individual clinical experience; it is also challenging to obtain firm scientific evidence that informs patient management and clinical decision-making. Improved attention to non-specific symptoms and signs and early diagnosis based on imaging may translate into better outcomes for this group of patients, many of whom are elderly with significant comorbidity.

Publication types

  • Review

MeSH terms

  • Decision Making*
  • Diagnosis, Differential
  • Diagnostic Imaging
  • Early Diagnosis
  • Esophageal Perforation / diagnosis*
  • Esophageal Perforation / etiology
  • Esophageal Perforation / therapy*
  • Esophagoscopy / methods
  • Humans
  • Iatrogenic Disease
  • Rupture, Spontaneous
  • Stents
  • Time Factors