Iatrogenic oesophageal perforations: a clinical review.
Thirty patients with iatrogenically induced perforation of the oesophagus were managed in our unit between January 1986 and December 1996. Thirteen (43%) of these injuries were referred after upper gastrointestinal endoscopy performed by physicians. Ten (33%) cases were referred by ENT surgeons and general surgeons referred 7 (23%) cases. Of these patients, 15 (50%) had no abnormality of the oesophagus found before perforation. Only 18 (60%) of patients were referred within 24 h of injury. The mean duration of care required in the intensive care unit was 1.5 days +/- 2.5 days and the mean inpatient hospital stay 26.5 days +/- 22.1 days. The mortality was 10% (three cases). Oesophageal perforation remains a serious life-threatening injury. The early diagnosis of this uncommon condition requires a high index of suspicion as the symptoms are often non-specific. Identification of the site of perforation is necessary as the management of cervical and thoracic perforations differs considerably. Early referral combined with appropriate therapy would appear to result in a better outcome than previously published data. It is therefore suggested that patients with this relatively rare condition should be referred as soon as possible to a centre with expertise in its management.
Lawrence
D R
DR
Department of Thoracic Surgery, Harefield Hospital, Middlesex.
Moxon
R E
RE
Fountain
S W
SW
Ohri
S K
SK
Townsend
E R
ER
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004939:Esophageal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D004945:Esophagoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013043:Specialties, Surgical; D016896:Treatment Outcome