Esophageal Perforation

Czech version

Authors: A. Pazdro; T. Haruštiak; M. Šnajdauf; M. Smejkal; J. Schützner; P. Pafko; J. Tvrdoň; R. Lischke
Authors‘ workplace: III. chirurgická klinika FN Praha-Motol, přednosta: doc. MUDr. R. Lischke, Ph. D.
Published in: Rozhl. Chir., 2011, roč. 90, č. 11, s. 647-652.
Category: Monothematic special - Original

Overview

Objective:
Evaluation of patients with acute esophageal perforations with single institution experience.

Material and methods:
The authors evaluate the set of 64 consecutive patients with esophageal perforation treated in our department between January 2000 and December 2010. In all patients were before decision making performed CT scans and X-ray examination with contrast agent administration. For selected patients was also accompanied upper endoscopy. Excluded were patients with malignant tracheoesophageal fistula and patients with perforation of malignant stenosis treated with palliative intent.

Results:
The mean age was 62 years (range 24–90), of which one third (34.4%) were aged 70 years or more. We received the iatrogenic perforation in 45 (70%) patients, less than one quarter (n = 15; 23%) consisted of spontaneous perforation, in three patients we have failed to determine the cause of perforation (5%) and one patient experienced perforation during removal of foreign body. Perforation of the thoracic esophagus in 41 patients, in 20 (31%) cases in the upper and middle third and 21 (33%) in the distal third of the thoracic esophagus. Cervical perforation was noted in 14 patients (22%) and abdominal of the 9 patients (14%). 92% of patients were treated surgically (n = 59). 43% (n = 27) were treated by primary suture of the perforation, esophageal resection with primary reconstruction was performed in 4 patients, esophagectomy with terminal esophagostomy and nutritional jejunostomy in 7 patients, 4 patients were treated by surgical drainage and only 7 patients, we introduced endless lavage. In 9 cases we have resected affected portion of esophagus with stapler closure in the chest. Conservative management of esophageal perforation we proceeded in 5 patients in whom a stent was introduced and the perforation successfully healed. Overall mortality in our set of patients is 23.4%.

Conclusion:
Conservative procedure in carefully selected patients could be an alternative to radical and inherently surgical procedures Published results and our little experience are encouraging, but this topic is still under study.

Key words:
esophageal perforation

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