La mortalité des perforations instrumentales de l’œsophage est élevée : expérience de 54 cas traités

Abstract

Objective: To underline the severity of instrumental esophageal perforations and to discuss their management. Patients and methods: Data from patients treated for instrumental esophageal perforation were collected retrospectively from 1980 to 1995 then prospectively since 1995 to 2000. Results: Fifty-four patients were treated for instrumental perforations. Perforation occurred after exploratory endoscopy ( n=24), endoscopic dilation ( n=13), attempted tracheal intubation ( n=5), foreign body extraction ( n=5), treatment of esophageal varices ( n=4), trans-esophageal echocardiography ( n=2), and duodenal prosthesis implantation ( n=1). Clinical manifestations were immediate in 18 cases and delayed in all others, with an interval before treatment ranging from 2 hours to 45 days (mean= 70 hours). All patients were operated after large spectrum antibiotherapy and intensive care, except 3 who were treated medically due to their poor general condition. Fourteen (26%) patients died, including the 3 non-operated ones. Conclusion: Instrumental esophageal perforations are associated with a high mortality, probably due to the poor general condition of the patients. Diagnosis of these perforations is often delayed. A good experience of endoscopic maneuveurs and adequate post-endoscopic monitoring could allow earlier surgical treatment with lower mortality.