Perforation of Barrett's ulcer: a challenge in esophageal surgery.
BACKGROUND
Barrett's ulcer, which develops within Barrett's esophagus, is frequently responsible for bleeding. Perforation is a rare complication constituting a great challenge for diagnosis and management.


METHODS
Three personal cases and 31 published reports of perforated Barrett's ulcer were reviewed retrospectively. The site of perforation, clinical presentation, management, and outcome were assessed.


RESULTS
The clinical presentation proved to be heterogeneous and was determined by the site of perforation: this was the pleural cavity (20% of cases), mediastinum (20%), left atrium (16.6%), tracheobronchial tract (13.3%), aorta (13.3%), pericardium (10%), or pulmonary vein (6.6%). Early esophagectomy and esophageal diversion-exclusion were the most frequent procedures, and overall mortality was 45%.


CONCLUSIONS
The poor prognosis of perforated Barrett's ulcer should be improved by earlier diagnosis and adequate emergent operation. Although early esophagectomy constitutes the recommended procedure, esophageal diversion-exclusion, which allows control of both sepsis and bleeding, is also of interest.
Guillem
P G
PG
Service de Chirurgie Digestive et Générale, CAO, CAEB, Hôpital Huriez, Lille, France.
Porte
H L
HL
Saudemont
A
A
Quandalle
P A
PA
Wurtz
A J
AJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D004939:Esophageal Perforation / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D015996:Survival Rate; D014456:Ulcer / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*