Diagnosis Of Esophageal Perforation Research Articles

Trends in the management and outcomes of esophageal perforations among racial-ethnic groups.

Esophageal perforation (EP) is a life-threatening emergency requiring emergent surgical intervention. Little is known about potential racial-ethnic disparities among patients with EP. Hospitalizations of adult (≥18 years old) patients admitted with a diagnosis of EP were identified in the 2000-2017 National Inpatient Sample (NIS). Multivariable Cox proportional hazards regression was used to estimate the association between race-ethnicity and inpatient mortality. Inpatient complications were assessed using multivariable logistic regression. There were an estimated 36,531 EP hospitalizations from 2000-2017. One quarter of hospitalizations were racial or ethnic minorities. Non-Hispanic (NH) White patients were, on average, older (median age 58 vs. 41 and 47 years, respectively, P<0.0001). The rate of EP admissions, per 1,000,000 the United States (US) adults, significantly increased among all groups over time. In-hospital mortality decreased for both NH White and NH Black patients (10.2% to 4.6% and 8.3% to 4.9%, respectively, P<0.0001) but increased for Hispanic patients and patients of other races (2.9% to 4.7% and 3.4% to 6.9%, P<0.0001). NH Black patients were more likely to have sepsis during their hospital course [odds ratio (OR) =1.34; 95% confidence interval (CI): 1.08 to 1.66], and patients of other races (OR =1.44; 95% CI: 1.01 to 2.07) were more likely to have pneumonia. Similar rates of surgical intervention were seen among all racial-ethic groups. After adjustment, inpatient mortality did not differ among racial-ethnic groups. Rates of EP admissions have increased for all racial-ethnic groups since 2000. Despite similar incidences of inpatient mortality across groups, NH Black and other race patients were more likely to experience postoperative complications, suggesting potential racial-ethnic disparities in quality or access to care.

A O05 MUlti-center cohort Study of Oesophageal Injuries and related Clinical outcomes (MUSOIC) study

Abstract Background Perforation of the oesophagus (OP) represent a potentially lethal yet poorly managed clinical condition due to its rarity, variation in clinical presentation and little consensus on the optimal management of these patients. Previous studies have shown that timely and appropriate treatment of OPs is the most important determinant of patient outcomes, and a delay in initiating the correct management within 24 hours increased the mortality rate from 10% to over 60%. Historically, patients have been managed based on the personal experience and preference of the surgeon, and accordingly most patients underwent surgical management based on data from small retrospective case series. Depending on the cause of injury, location of perforation and status of the patient, options include conservative management; endoscopy (stenting or clipping); and surgery (drainage, diversion, primary repair, or oesophagectomy). Currently, there are no recent large-scale studies investigating the outcomes in oesophageal perforation, leading to a paucity of high-grade evidence on the management of oesophageal injuries. This study aims to characterise the variation in the management of OPs, update its epidemiology in the UK; and evaluate the mortality and morbidity outcomes of surgical and non-surgical modalities in managing OP. Methods This was a multi-centred cohort study involving eligible centers from the Association of Upper Gastro-intestinal Surgeons for Great Britain and Ireland (AUGIS) research network. All adult patients who were admitted with a diagnosis of esophageal perforation (iatrogenic, spontaneous or traumatic causes) and managed as an inpatient for more than 24 hours were included in the study. Exclusion criteria were as follows: pediatric population; OP due to anastomotic leaks post-esophagectomy; and unavailability of data matching primary outcome measures. The time period for inclusion of patients was from January 2016 to December 2020. Investigators were asked to actively monitor patients and their electronic medical records to identify post-intervention complications up to 90 days from time of intervention if appropriate. The primary outcome was 90-day mortality. Other secondary outcomes included the incidence of complications secondary to OP or interventions; incidence of 30-day re-intervention; length of hospital stay (LOS) and intensive care unit (ICU) stay; readmission within 30 days; and recurrence. Results During the study period 369 patients with oesophageal perforation from eight centres and were included in the study. The mean age of the population was 63 (18) years, body mass index was 25 (9)kg/m2, 60% were male, 30% were ASA grade 3, and 41% ECOG performance status 0. The aetiology of OP was spontaneous in 57% and iatrogenic in 37%. The mean time from presentation to referral and intervention were 37 hours and 111 hours respectively. In patients transferred from a district general to a tertiary hospital the mean time from presentation to transfer was 100 hours. Surgery was used as the primary treatment approach in 31%, endoscopic intervention in 10% and conservative management in 56%. Thoractomy and laparotomy was used in 20% and 24% respectively, endosponge and endoscopic stent used in 11% and 7% respectively. 90-day mortality was 20% across the cohort, 30-day re-admission rate was 18%, mean ICU stay, and LOS were 10 days and 37 days respectively. 90-day mortality was significantly reduced in the surgery group (9%) when compared with endoscopic (24%) and conservative management groups (28%) (p&amp;lt;0.001). Multivariate analyses identified key patient, procedural, and treatment factors associated with mortality from oesophageal perforation. Conclusions In a centralised oesophageal and gastric cancer service, the management of complex upper gastrointestinal conditions including oesophageal perforation is most commonly centralised to oesophageal and gastric cancer centres. This large multi-centre collaborative study provides robust data concerning modern practices of the management of oesophageal perforation in the UK. Through a detailed and highly granular dataset, we have examined factors associated with the patient pathway, presentation and treatment that are associated with mortality following oesophageal perforation.

Radiofrequency ablation-induced esophageal perforation

Esophageal perforation (EP) can be a complication of radiofrequency ablation, a standard treatment for certain patients with drug-refractory atrial fibrillation. This article discusses the etiology, clinical manifestations, and diagnosis of EP, as well as nursing care for patients with EP.

Neonatal oesophageal perforation: The role for non‐operative management

Isolated oesophageal perforation in neonates is a rare but potentially life-threatening condition. Although management has historically been operative, conservative management (antibiotics, bowel rest, parenteral nutrition) is now more routinely used. The aim of this study was to evaluate the management of this condition in two large neonatal surgical centres. A retrospective cohort study was conducted for neonates admitted to The Hospital for Sick Children (Toronto, Canada) or The Royal Children's Hospital (Melbourne, Australia) with a diagnosis of oesophageal perforation, from 2006 to 2016. Patients with oesophageal atresia or tracheo-oesophageal fistula were excluded. Data were collected from chart review regarding demographics, clinical course, management and outcomes. Eleven neonates with oesophageal perforation were identified over a 10-year period at the two centres. Median gestational age at birth was 25.3 weeks (interquartile range 24.2-28.8) and the majority (7/11, 64%) of neonates were extremely low birthweight. Diagnosis was made on day 1 of life for 9 of 11 (81%) neonates and was secondary to nasogastric tube insertion in 10 of 11 (91%) neonates. Only four (36%) neonates had symptomatic complications. All neonates were managed with bowel rest and intravenous antibiotics for a median of 7 days (interquartile range 7-10); two patients required operative intervention. Three neonates (27%) developed chronic lung disease and two (19%) died prior to discharge. Oesophageal perforation is severe complication secondary to instrumentation of the upper gastrointestinal tract in neonates. Prompt and accurate diagnosis is crucial. Non-operative management is effective for the majority, though morbidity is common.

Conservative Treatment with Octreotide to Provide Early Recovery of Children with Esophageal Perforation.

The effectiveness of nonoperative treatment of esophageal perforation (EP) in children with octreotide is highlighted. Records of nine patients (seven boys and two girls with an average age of 5.83 ± 5.35 years) with EP were reviewed. EP developed in six patients during dilation of esophageal stenosis (five of six caused by caustic burns). In the other three patients, EP developed after nasogastric placement, after endotracheal intubation, and during endoscopy for foreign body. The symptoms consisted of dyspnea in four patients, tachypnea in seven patients, fever in six patients, chest pain in two patients, and abdominal pain in one patient. Two patients had pneumomediastinum, four patients had pleural effusion, one patient had subcutaneous emphysema, four patients had pneumothorax, and two patients had severe sepsis. Eight of the perforations resolved spontaneously. Therapy included cessation of oral feedings, implementation of proper antibiosis, parenteral and/or enteral nutrition by gastrostomy, and drainage of pleural effusions or mediastinal abscesses if required. Though not recommended by literature, octreotide was administered to these patients. Only one patient was operated in another clinic and was lost during follow-up. The length of hospitalization stay had a median of 11 ± 6.59 days, ranging between 5 and 28 days. If the patient who was operated and did not receive octreotide therapy is excluded, the median hospitalization was only 8 days (5 to 12 days). All patients in our series (except patient 8) survived and still have their native esophagus. The initiation of octreotide treatment in the early period after diagnosis of EP without surgical intervention leads to early improvement in children.

Bilateral Empyema due to Spontaneous Esophageal Perforation

We report the case of a 50-year-old man, with no signi“cant clinical history, who presented in an emergency department in the city of Cuzco with a 3-day history of nausea, vomiting, and progressive dyspnea. Chest X-ray revealed bilateral pleural effusion. Cytochemical analysis of the pleural ”uid was consistent with empyema. The patient developed progressive respiratory failure requiring mechanical ventilation and transfer to the intensive care unit (ICU), where he was treated with wide-spectrum antibiotics and bilateral chest drainage. He was extubated 10 days later, and transferred to our ICU in Lima. On arrival, his bilateral empyema persisted, so a computed tomography was performed with oral contrast medium, showing esophageal perforation (Fig. 1). The diagnosis of esophageal perforation was con“rmed on upper endoscopy, showing an ogivalshaped rupture in the posterior esophageal wall communicating with the mediastinum 3 cm from the gastroesophageal junction. The “stula was closed with metal clips and a nasojejunal tube was placed. The patient’s progress was favorable, enteral nutrition was well tolerated, and no signs of sepsis or respiratory failure were observed. After placement of the clips, chest drainage reduced progressively to less than 100 cc/24 h. This situation was maintained until the patient was discharged and transferred to Germany to continue his recovery, where the clips were “nally removed.

OC-075 Management and outcomes of oesophageal perforation: a national study of 2564 patients in england

Introduction Traditionally oesophageal perforation is a rare clinical emergency that confers a high rate of mortality and major morbidity. The aim of the present study was to determine patient and hospital-related factors associated with mortality from oesophageal perforation. Method Patients admitted with a diagnosis of oesophageal perforation between 2001–2012 were identified. Comparative analysis was performed for the effect of hospital volume on clinical outcomes. Quartile thresholds used to divide hospitals were 1–14 (Lowest Volume (LV)), 15–20 (Low Middle Volume (LMV)), 21–35 (High Middle Volume (HMV)), and ≥36 cases (High Volume (HV)). Results Over the twelve-year study period 2,564 patients with oesophageal perforation were treated at 158 hospitals. The 30-day and 90-day mortality rates were 30.0% and 38.8% respectively. There was a significant increase in the percentage of patients managed supportively and a reduction in surgical management over time. Furthermore there were significant reductions in 30-day (36.6% to 24.9%; P Important patient demographics associated with 30-day and 90-day mortality included age ≥70, preoperative congestive cardiac failure, ischaemic heart, liver, and renal disease. High hospital volume was associated with significant reductions in 30-day (OR = 0.68; P = 0.001) and 90-day mortality (OR = 0.69; P = 0.001). Subset analysis of patients undergoing endoscopic intervention, identified hospital volume as an important factor associated with mortality. Conclusion This study provides evidence for the centralization of management of oesophageal perforation to high volume centres with appropriate multi-disciplinary infrastructure to treat these complex patients. Disclosure of interest None Declared.

解離性大動脈瘤破裂による食道穿破の診断に上部消化管内視鏡が有用であった1例

解離性大動脈瘤破裂による食道穿破の診断に上部消化管内視鏡が有用であった1例

Conservative Management of an Iatrogenic Esophageal Tear in Kenya.

Since its description over 250 years ago, diagnosis of esophageal perforation remains challenging, its management controversial, and its mortality high. This rare, devastating, mostly iatrogenic, condition can quickly lead to severe complications and death due to an overwhelming inflammatory response to gastric contents in the mediastinum. Diagnosis is made with the help of esophagograms and although such tears have traditionally been managed via aggressive surgical approach, recent reports emphasize a shift in favor of nonoperative care which unfortunately remains controversial. We here present a case of an iatrogenic esophageal tear resulting from a routine esophagoscopy in a 50-year-old lady presenting with dysphagia. The esophageal tear, almost missed, was eventually successfully managed conservatively, thanks to a relatively early diagnosis.

Management and complications associated with treatment of cervical oesophageal perforations in horses

SummarySix horses were evaluated for colic and anorexia, choke or suspected oesophageal rupture with and without tracheal laceration. Clinical findings were variable, but a painful ventral neck swelling was noted in all cases. Two of the horses had signs of dehydration and sepsis. Additional findings included evidence of previous trauma over the trachea and oesophagus, ventral neck abscessation, choke and aspiration pneumonia. A diagnosis of oesophageal perforation was made using endoscopy. Two horses were subjected to euthanasia without treatment. All horses where treatment was attempted received debridement of the oesophageal perforation and surrounding tissues with or without surgical closure of the oesophageal defect. Other therapies included broad spectrum antimicrobials, anti‐inflammatory drugs, fluid and nutritional support as well as additional therapeutics for sepsis and individual complications. Complications included diverticulum formation, thrombophlebitis, diarrhoea, laryngeal hemiplegia, azotaemia, aspiration pneumonia, oesophageal obstruction, weight loss and laminitis. All 4 treated horses recovered from the oesophageal perforation and are able to eat a normal diet. Two of the 4 horses have had infrequent episodes of recurrent choke. Oesophageal rupture should be considered as a differential diagnosis for horses with a painful swelling of the ventral neck. With surgical debridement and adequate supportive care, oesophageal perforation cases can have a fair to good long‐term survival, although chronic complications can occur, therapy is prolonged, and a significant economic commitment is required.

Clinical signs and radiographic evidence of esophageal perforation after tetraplegia

A diagnosis of esophageal perforation at some time after cervical spine surgery is difficult to establish since there exists no clinical picture specific to tetraplegic patients. We carried out a detailed retrospective study of revelatory clinical manifestations and conventional radiographic data in a series of 16 patients hospitalized at Hôpital Henry-Gabrielle (Lyon, France) for rehabilitation purposes between 1983 and 2010 and who presented this complication. The most frequent clinical picture associates cervical pain, fever and dysphagia. Simple front and side X-rays of the cervical spine led in 77% of the cases to a diagnosis of esophageal perforation. The most prevalent radiographic signs of the latter consist in osteosynthesis hardware or instrumentation failure, prevertebral free air next to the cervical esophagus and enlarged prevertebral space. Visualized esophageal X-rays, also known as series, highlight parenchymal opacity next to the posterior wall of the esophagus. A diagnosis of esophageal perforation needs to be carried out in order to facilitate suitable treatment and avoid the compromising of vital functions.

Traitement conservateur d’une perforation traumatique de l’oesophage thoracique

Introduction : Esophageal perforation secondary to blunt trauma carries a high morbidity and mortality rates. It is a rare disease. Cervical esophagus is the commonest site of perforation. Numerous options are available for the management of esophageal injuries. The conservative medical management is allowed in well defined cases. Case presentation : We report a rare clinical case of a 40-year- old patient who was injured in a car accident with an impact to the anterior chest. At the time of admission, the patient was alert and complained of chest pain. Clinical findings showed of subacute ischemia in the right upper limb. Chest computed tomography (CT) with intraveinous contrast showed thrombosis of the brachiocephalic artery “a few air bubbles, in the upper mediastinum and a bilateral pneumothorax”. The diagnosis of esophageal perforation was confirmed by a second CT with ingestion of a water-soluble contrast agent. Outcome was favourable on antibiotics and parenteral nutrition. Conclusion : Provided that no clinical signs of sepsis are present and that the patient rapidly improves the conservative management of traumatic perforation of the thoracic oesophagus is a sounded option.

Spontaneous Esophageal Perforation in a Patient with Mixed Connective Tissue Disease

Spontaneous esophageal perforation is a rare and life-threatening disorder. Failure to diagnosis within the first 24-48 hours of presentation portends a poor prognosis. A patient with mixed connective tissue disease (MCTD) on low-dose prednisone and methotrexate presented moribund with chest and shoulder pain, a left hydropneumothorax, progressive respiratory failure and shock. Initial management focussed on presumed community acquired pneumonia (CAP) in a patient on immunosuppressants. Bilateral yeast empyemas were treated and attributed to immunosuppression. On day 26, the patient developed mediastinitis, and the diagnosis of esophageal perforation was first considered. A review of the literature suggests that the diagnosis and management of spontaneous esophageal perforation could have been more timely and the outcome less catastrophic.

Esophageal perforation caused by external air-blast injury

BackgroundEsophageal perforation after external air-blast trauma is rarely presented in the emergency room. The diagnosis is often delayed more than 24 hours.MethodsWe review the literature and report a case of esophageal perforation caused by external air-blast injury.ResultsIncluding the present case, a total of 5 cases of esophageal perforation were caused by external air-blast injury in English literature. Of them, the common presentations were chest pain and dyspnea. The treatment methods varied with each case. One patient died before diagnosis of esophageal perforation and the others survived after proper surgical management.ConclusionsEarly diagnosis and proper surgical management can reduce the morbidity and mortality of patients who suffered from esophageal perforation caused by external air-blast injury.

Esophageal perforation after laparoscopic surgery: A mistake in the radiologic diagnosis

Esophageal perforation is a life-threatening condition with significant morbidity and mortality in which early detection is crucial for the initiation of optimum treatment [Cole T, Turner M. Manifestations of gastrointestinal disease on chest radiographs. RadioGraphics 1993;13:1013–34; Gupta N, Kaman L. Personal management of 57 consecutive patients with esophageal perforation. Am J Surg 2004;187:58–63]. The most common cause of esophageal perforation is iatrogenic esophageal injury during either esophageal dilation or endoscopy [Cole T, Turner M. Manifestations of gastrointestinal disease on chest radiographs. RadioGraphics 1993;13:1013–34; Kimchi E, Staveley-O’Carroll K. Esophageal perforation. OTGS 2006;8:156–60]. The rarity of this condition and its nonspecific presentations lead to diagnostic and treatment delay in more than 50% of perforations [Gupta N, Kaman L. Personal management of 57 consecutive patients with esophageal perforation. Am J Surg 2004;187:58–63]. Diagnosis is made with a chest X-ray, CT of the thorax and abdomen, and with a swallow study with water-soluble medium contrast [Kimchi E, Staveley-O’Carroll K. Esophageal perforation. OTGS 2006;8:156–60; Gimenez A, Franquet T, Erasmus J, et al. Thoracic complications of esophageal disorders. RadioGraphics 2002;22:S247–58; Kuhlman J, Pozniak M, Collins J, et al. Radiographic and CT findings of blunt chest trauma: aortic injuries and looking beyond them. RadioGraphics 1998;18:1085–1106]. When diagnosis of esophageal perforation is delayed, morbidity and mortality increases substantially. Alternatives of treatment include nonoperative management or surgical procedures with primary repair, muscle patches, muscle flaps, esophageal diversion or esophagectomy [Kimchi E, Staveley-O’Carroll K. Esophageal perforation. OTGS 2006;8:156–60; Gimenez A, Franquet T, Erasmus J, et al. Thoracic complications of esophageal disorders. RadioGraphics 2002;22:S247–58]. We report a 63-year-old man with an esophageal perforation after laparoscopic repair of chronic gastric volvulus, the radiologic mistake in diagnosis which conditionated delay in treatment, and the surgical management.

Trends of Heller Myotomy Hospitalizations for Achalasia in the United States, 1993-2005: Effect of Surgery Volume on Perioperative Outcomes

Achalasia is a rare chronic disorder of esophageal motor function. Single-center reports suggest that there has been greater use of laparoscopic Heller myotomy for achalasia in the United States since its introduction in 1992. We aimed to study the trends of Heller myotomy and the relationship between surgery volume and perioperative outcomes. The Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) is a 20% stratified sample of all hospitalizations in the United States. It was used to study the macro-trends of Heller myotomy hospitalizations during 1993-2005. We also used the NIS 2003-2005 micro-data to study the perioperative outcomes of Heller myotomy hospitalizations, using other achalasia and laparoscopic cholecystectomy hospitalizations as control groups. The generalized linear model with repeated observations from the same unit was used to adjust for multiple hospitalizations from the same hospital. The national estimate of Heller myotomy hospitalizations increased from 728 to 2,255 during 1993-2005, while its mean length of stay decreased from 9.9 to 4.3 days. Of the 1,117 Heller myotomy hospitalizations in the NIS 2003-2005, 10 (0.9%) had the diagnosis of esophageal perforation at discharge. Length of stay was negatively correlated with a hospital's number of Heller myotomy per year (correlation coefficient -0.171, P < 0.001). In multivariate log-linear regressions with a control group, a hospital's number of Heller myotomy per year was negatively associated with length of stay (coefficient -0.215 to -0.119, both P < 0.001) and total charges (coefficient -0.252 to -0.073, both P < 0.10). These findings were robust in alternative statistical models, specifications, and subgroup analyses. On a national level, the introduction of laparoscopic Heller myotomy for achalasia was associated with greater use of surgery and shorter length of stay. A larger volume of Heller myotomy in a hospital was associated with better perioperative outcomes in terms of shorter length of stay and lower total charges.

The Sealing Effect of a Fibrin Tissue Patch on the Esophageal Perforation Area in Primary Repair

The aim of this study was to investigate the efficacy of the fibrin tissue patch and to analyze its use in patients with esophageal perforation. We studied 28 patients who were diagnosed with esophageal perforation between January 1990 and January 2006 at Akdeniz University Hospital. Sixteen (57.14%) were male. The average age was 59 +/- 9 years. We performed surgery and primary repair reinforcement even if the diagnosis of esophageal perforation was late. Twenty-three (82.14%) perforations were the result of endoscopic instruments; spontaneous perforations occurred in three (10.71%) patients. Postoperative complication (Heller myotomy) caused perforation in one patient (3.57%) and blunt trauma in one patient (3.57%). Three (10.71%) patients had cervical perforation, and 25 (89.29%) patients had thoracic esophageal perforation. Twelve (42.86%) patients underwent emergency surgery (within the first 24 h). Ten (35.71%) patients underwent surgery within 48 h, and the remaining 6 (21.43%) underwent surgery after 48 h. Nine (32.14%) patients had primary repair, 7 (25%) had reinforcement of the primary repair with fibrin tissue patch, 7 (25%) had esophagectomy and gastric pull-up, and 2 (7.14%) had drainage and placement of metallic stents. In four patients of the nine who had primary repair, fistula complication was detected, whereas in only one of the seven who had reinforcement of the primary repair with fibrin tissue patch was a fistula detected. Three patients (10.71%), two of whom had Boerhaave's syndrome, died. Surgical primary repair with fibrin tissue patch is the most successful treatment option in the management of esophageal perforation.

Esophageal perforation caused by fish vertebra ingestion in a seven-month-old infant demanded surgical intervention: A case report

A seven-month-old infant was admitted to our hospital with a 1-wk history of shortness of breath, dysphagia, and fever. Diagnosis of esophageal perforation following fish vertebra ingestion was made by history review, pneumomediastinum and an irregular hyperdense lesion noted in initial chest radiogram. Neck computed tomography (CT) confirmed that the foreign body located at the cricopharyngeal level and a small esophageal tracheal fistula was shown by esophagogram. The initial response to treatment of fish bone removal guided by panendoscopy and antibiotics administration was poor since pneumothorax plus empyema developed. Fortunately, the patient's condition finally improved after decortication, mediastinotomy and perforated esophagus repair. To our knowledge, this is the first case report of esophageal perforation due to fish bone ingestion in infancy. In addition to particular caution that has to be taken when feeding the innocent, young victim, it may indicate the importance of surgical intervention for complicated esophageal perforation in infancy.

Oesophageal perforation in preterm neonates: not an innocent bystander.

To compare the clinical course and neonatal outcomes of preterm infants with oesophageal perforation (OP). Retrospective case control study of infants admitted between 1994 and 2001 and diagnosed with OP was performed at two tertiary care centres in Toronto, Canada. One control per case was matched by the gestational age and the month of birth. Occurrence of air leak syndrome/pleural effusion requiring drainage, the duration of supplemental oxygen and the time to attain full feeds were compared. Ten cases of OP were identified. The commonest clinical presentation was air leak syndrome/pleural effusion. There was a statistically significant increase in the time to attain full enteral feeds in OP group (P = 0.02). The duration of supplemental oxygen was prolonged in infants with OP, however, this was statistically insignificant (P = 0.20). The infants were managed conservatively and perforation healed in all. Oesophageal perforation is a rare but important complication of modern neonatal intensive care setting. The diagnosis of OP should be considered in infants who present with sudden/acute deterioration in their respiratory status following procedures involving pharyngeal region. Conservative management in an otherwise uncomplicated case leads to complete recovery in neonates.

Surgical Management of Esophageal Perforation: Role of Esophageal Conservation in Delayed Perforation

Definitive repair of esophageal perforation is considered the preferred treatment for patients presenting early (<24 hours). However, the optimal management of delayed presentation (>24 hours) has not been well defined. This study examined the management of esophageal perforation and compared the outcomes of early versus delayed presentation. Records of patients admitted with the diagnosis of esophageal perforation were reviewed. Contrast studies were used to confirm the diagnosis in all cases. Patient demographics and outcome were analyzed to determine differences between early and delayed presentation. A total of 22 cases of esophageal perforation were identified (eight early vs 14 delayed presentations). Operative interventions included primary repair (four), reinforced repair (14) either with intercostal muscle or pleural flap, and a complete esophageal resection (one). Debridement and drainage without repair were done in two patients and a proximal intramural tear was treated with antibiotics and observation. Two patients died during hospitalization. All surviving patients had near-normal restoration of esophageal function. Follow-up at 3 years has shown minimal gastrointestinal problems. One patient required repeat esophageal dilatations and two patients underwent antireflux therapy. Esophageal repair should be considered in all cases of nonmalignant esophageal perforation and should not be influenced by the time of presentation.