Esophageal Perforation
Abstract
Esophageal perforation is a rare condition with low incidence rate. Regardless, it is a surgical emergency due to its high mortality rate when diagnosis and management are delayed. The most common cause is iatrogenic perforation from upper gastrointestinal endoscopy. The clinical presentation varies and is unspecific; all dependent on the etiology, location, size, contamination and time taken for diagnosis. The principle of management includes stabilization and hemodynamic support, to prevent and eliminate contamination through the perforation site, provides adequate drainage and nutritional support. Lastly repair and restore continuity of digestive tract, the restoration is feasible through conservative, endoscopic or surgical treatment. Each option possessed its own advantages and disadvantages therefore decisions should be determined individually and specifically for the patient's best outcome.
References
Barrett NR. Spontaneous perforation of the oesophagus; review of the literature and report of three new cases. Thorax. 1946;1:48-70.
Barrett NR. Report of a case of spontaneous perforation of the oesophagus successfully treated by operation. Br J Surg. 1947;35(138):216-218.
Satinsky VP, Kron SD. One-stage esophagectomy in presence of mediastinitis. AMA Arch Surg. 1952;64(1):124-127.
Jones WG, 2nd, Ginsberg RJ. Esophageal perforation: a continuing challenge. Ann Thorac Surg. 1992;53(3):534-543.
Oezcelik A, DeMeester SR. General anatomy of the esophagus. Thorac Surg Clin. 2011;21(2):289-297, x.
Brinster CJ, Singhal S, Lee L, Marshall MB, Kaiser LR, Kucharczuk JC. Evolving options in the management of esophageal perforation. Ann Thorac Surg. 2004;77(4):1475-1483.
Kavic SM, Basson MD. Complications of endoscopy. Am J Surg. 2001;181(4):319-332.
Lee JG, Lieberman DA. Complications related to endoscopic hemostasis techniques. Gastrointest Endosc Clin N Am. 1996;6(2):305-321.
Nair LA, Reynolds JC, Parkman HP, et al. Complications during pneumatic dilation for achalasia or diffuse esophageal spasm. Analysis of risk factors, early clinical characteristics, and outcome. Dig Dis Sci. 1993;38(10):1893-1904.
White RK, Morris DM. Diagnosis and management of esophageal perforations. Am Surg. 1992;58(2):112-119.
Derbes VJ, Mitchell RE, Jr. Hermann Boerhaave's Atrocis, nec descripti prius, morbi historia, the first translation of the classic case report of rupture of the esophagus, with annotations. Bull Med Libr Assoc. 1955;43(2):217-240.
Pate JW, Walker WA, Cole FH, Jr., Owen EW, Johnson WH. Spontaneous rupture of the esophagus: a 30-year experience. Ann Thorac Surg. 1989;47(5):689-692.
Asensio JA, Chahwan S, Forno W, et al. Penetrating esophageal injuries: multicenter study of the American Association for the Surgery of Trauma. J Trauma. 2001;50(2):289-296.
Beal SL, Pottmeyer EW, Spisso JM. Esophageal perforation following external blunt trauma. J Trauma. 1988;28(10):1425-1432.
Lam HC, Woo JK, van Hasselt CA. Esophageal perforation and neck abscess from ingested foreign bodies: treatment and outcomes. Ear Nose Throat J. 2003;82(10):786, 789-794.
Nesbitt JC, Sawyers JL. Surgical management of esophageal perforation. Am Surg. 1987;53(4):183-191.
Griffiths EA, Yap N, Poulter J, Hendrickse MT, Khurshid M. Thirty-four cases of esophageal perforation: the experience of a district general hospital in the UK. Dis Esophagus. 2009;22(7):616-625.
Panzini L, Burrell MI, Traube M. Instrumental esophageal perforation: chest film findings. Am J Gastroenterol. 1994;89(3):367-370.
Han SY, McElvein RB, Aldrete JS, Tishler JM. Perforation of the esophagus: correlation of site and cause with plain film findings. AJR Am J Roentgenol. 1985;145(3):537-540.
Chirica M, Champault A, Dray X, et al. Esophageal perforations. J Visc Surg. 2010;147(3):e117-128.
Foley MJ, Ghahremani GG, Rogers LF. Reappraisal of contrast media used to detect upper gastrointestinal perforations: comparison of ionic water-soluble media with barium sulfate. Radiology. 1982;144(2):231-237.
Backer CL, LoCicero J, 3rd, Hartz RS, Donaldson JS, Shields T. Computed tomography in patients with esophageal perforation. Chest. 1990;98(5):1078-1080.
White CS, Templeton PA, Attar S. Esophageal perforation: CT findings. AJR Am J Roentgenol. 1993;160(4):767-770.
Horwitz B, Krevsky B, Buckman RF, Jr., Fisher RS, Dabezies MA. Endoscopic evaluation of penetrating esophageal injuries. Am J Gastroenterol. 1993;88(8):1249-1253.
Cameron JL, Kieffer RF, Hendrix TR, Mehigan DG, Baker RR. Selective nonoperative management of contained intrathoracic esophageal disruptions. Ann Thorac Surg. 1979;27(5):404-408.
Altorjay A, Kiss J, Voros A, Bohak A. Nonoperative management of esophageal perforations. Is it justified? Ann Surg. 1997;225(4):415-421.
Bladergroen MR, Lowe JE, Postlethwait RW. Diagnosis and recommended management of esophageal perforation and rupture. Ann Thorac Surg. 1986;42(3):235-239.
Fischer A, Thomusch O, Benz S, von Dobschuetz E, Baier P, Hopt UT. Nonoperative treatment of 15 benign esophageal perforations with self-expandable covered metal stents. Ann Thorac Surg. 2006;81(2):467-472.
Turkyilmaz A, Eroglu A, Aydin Y, Kurt A, Bilen Y, Karaoglanoglu N. Complications of metallic stent placement in malignant esophageal stricture and their management. Surg Laparosc Endosc Percutan Tech. 2010;20(1):10-15.
Kiev J, Amendola M, Bouhaidar D, Sandhu BS, Zhao X, Maher J. A management algorithm for esophageal perforation. Am J Surg. 2007;194(1):103-106.
Freeman RK, Van Woerkom JM, Ascioti AJ. Esophageal stent placement for the treatment of iatrogenic intrathoracic esophageal perforation. Ann Thorac Surg. 2007;83(6):2003-2007; discussion 2007-2008.
Qadeer MA, Dumot JA, Vargo JJ, Lopez AR, Rice TW. Endoscopic clips for closing esophageal perforations: case report and pooled analysis. Gastrointest Endosc. 2007;66(3):605-611.
Disibeyaz S, Koksal AS, Parlak E, Torun S, Sasmaz N. Endoscopic closure of gastrointestinal defects with an over-the-scope clip device. A case series and review of the literature. Clin Res Hepatol Gastroenterol. 2012;36(6):614-621.
Hagel AF, Naegel A, Lindner AS, et al. Over-the-scope clip application yields a high rate of closure in gastrointestinal perforations and may reduce emergency surgery. J Gastrointest Surg. 2012;16(11):2132-2138.
Brangewitz M, Voigtlander T, Helfritz FA, et al. Endoscopic closure of esophageal intrathoracic leaks: stent versus endoscopic vacuum-assisted closure, a retrospective analysis. Endoscopy. 2013;45(6):433-438.
Smallwood NR, Fleshman JW, Leeds SG, Burdick JS. The use of endoluminal vacuum (E-Vac) therapy in the management of upper gastrointestinal leaks and perforations. Surg Endosc. 2016;30(6):2473-2480.
Laukoetter MG, Mennigen R, Neumann PA, et al. Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): a prospective cohort study. Surg Endosc. 2017;31(6):2687-2696.
Bufkin BL, Miller JI, Jr., Mansour KA. Esophageal perforation: emphasis on management. Ann Thorac Surg. 1996;61(5):1447-1451; discussion 1451-1442.
Yeginsu A, Ergin M, Erkorkmaz U. Strength of esophageal closure techniques with and without tissue reinforcement. World J Surg. 2007;31(7):1445-1448.
Cho S, Jheon S, Ryu KM, Lee EB. Primary esophageal repair in Boerhaave's syndrome. Dis Esophagus. 2008;21(7):660-663.
Gupta NM, Kaman L. Personal management of 57 consecutive patients with esophageal perforation. Am J Surg. 2004;187(1):58-63.
Linden PA, Bueno R, Mentzer SJ, et al. Modified T-tube repair of delayed esophageal perforation results in a low mortality rate similar to that seen with acute perforations. Ann Thorac Surg. 2007;83(3):1129-1133.
Rohatgi A, Papanikitas J, Sutcliffe R, Forshaw M, Mason R. The role of oesophageal diversion and exclusion in the management of oesophageal perforations. Int J Surg. 2009;7(2):142-144.
Kaman L, Iqbal J, Kundil B, Kochhar R. Management of Esophageal Perforation in Adults. Gastroenterology Res. 2010;3(6):235-244.
