[Mortality from iatrogenic esophageal perforations is high: experience of 54 treated cases].
OBJECTIVE
To underline the severity of instrumental esophageal perforations and to discuss their management.


METHODS
Data from patients treated for instrumental esophageal perforation were collected retrospectively from 1980 to 1995 then prospectively since 1995 to 2000.


RESULTS
Fifty-four patients were treated for instrumental perforations. Perforation occurred after exploratory endoscopy (n = 24), endoscopic dilation (n = 13), attempted tracheal intubation (n = 5), foreign body extraction (n = 5), treatment of esophageal varices (n = 4), trans-esophageal echocardiography (n = 2), and duodenal prosthesis implantation (n = 1). Clinical manifestations were immediate in 18 cases and delayed in all others, with an interval before treatment ranging from 2 hours to 45 days (mean = 70 hours). All patients were operated after large spectrum antibiotherapy and intensive care, except 3 who were treated medically due to their poor general condition. Fourteen (26%) patients died, including the 3 non-operated ones.


CONCLUSIONS
Instrumental esophageal perforations are associated with a high mortality, probably due to the poor general condition of the patients. Diagnosis of these perforations is often delayed. A good experience of endoscopic maneuveurs and adequate post-endoscopic monitoring could allow earlier surgical treatment with lower mortality.
Jougon
J
J
Service de chirurgie thoracique, hôpital de Haut-Lévèque, CHU de Bordeaux, 33604 Pessac, France. jacques.jougon@chu-bordeaux.fr
Delcambre
F
F
MacBride
T
T
Minniti
A
A
Velly
J F
JF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004724:Endoscopy; D004939:Esophageal Perforation / Q000209:etiology* / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007362:Intensive Care Units; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D013525:Surgical Instruments