Cervical esophageal perforation: a 10-year clinical experience in north of iran.

Abstract

Perforations of the cervical esophagus are infrequent severe conditions associated with a high rate of morbidity and mortality if misdiagnosed. The diagnosis and management of cervical esophageal perforation remains a challenging clinical problem. We aimed to present our experience of the etiology, presentation, management and outcome of cervical esophageal perforation in a 10years period. In this cross-sectional study, we reviewed the records of all patients with a diagnosis of cervical esophageal perforation admitted at the teaching Razi Hospital of Rasht, north of Iran, between 2001 and 2011. 26 patients (15 male) were studied with mean age of 47.6±13.78years, a range from 10 to 68years. Only 16 (61.5%) of patients were referred within 24h of injury. The etiology was iatrogenic in 15 cases (57.69%), foreign body ingestion in 7 cases (26.9%), and penetrating traumatic injury in 4 cases (15.4%). The common clinical manifestations of perforation were neck pain in 22 cases (84.6%), fever in 19 cases (73.1%), and subcutaneous emphysema in 12 cases (46.2%). Barium and gastrografin swallow were performed in 57.7 and 23.1% of patients, respectively and flexible esophagoscopy was used in 23.06%. Most of patients (65.4%) were managed by primary repair. Overall, mortality rate was 7.7%. Our study demonstrates that the most common cause of cervical esophageal perforation is iatrogenic injury. Clinical suspicion is most important problem. Furthermore, Diagnosis is mainly made by Barium and gastrografin swallow. For a successful outcome, primary repair is a preferred treatment for most perforation patients.