title: Management of iatrogenous esophagus perforation.
abstract: OBJECTIVE
  The management of patients with iatrogenous, instrumentally caused esophageal disruptions is still a controversially discussed challenge for any physician. We reviewed indications, morbidity, and mortality of esophagectomy compared to less aggressive treatment schemes in the light of our single-unit experience.
  
  
  METHODS
  We reviewed the cases of 38 consecutive patients suffering from iatrogenous esophageal disruption treated within the last 10 years at the University Medical School Graz.
  
  
  RESULTS
  Severe sepsis was diagnosed in seventeen patients; fourteen of the seventeen patients were treated by esophagectomy followed by primary or secondary reconstruction at a mortality rate of 28.6 % (four of fourteen patients). All fourteen patients thus treated had major preexisting esophageal pathologies. In three of the total seventeen cases reviewed, conservative treatment modalities were used. The mortality rate in the non-septic group treated by direct suturing (n = 21) was 4.8 % (one of twenty-one patients). Major preexisting esophageal pathology was present in thirteen. The overall mortality was 13.2 % (five of thirty-eight patients).
  
  
  CONCLUSIONS
  The strategy of primary repair for iatrogenous esophageal injury should only be adopted in patients with minor or without intrinsic esophageal disease, and in the absence of severe sepsis suggesting mediastinitis. Severe sepsis following iatrogenous esophageal trauma should prompt the decision for esophagectomy where anatomically and/or oncologically possible.
authors.affiliation: Department of Surgery, Division of Thoracic and Hyperbaric Surgery, University Medical School, Graz, Austria. florian.tomaselli@kfunigraz.ac.at
authors.forename: F
authors.initials: F
authors.lastname: Tomaselli
authors.forename: A
authors.initials: A
authors.lastname: Maier
authors.forename: H
authors.initials: H
authors.lastname: Pinter
authors.forename: F
authors.initials: F
authors.lastname: Smolle-Jüttner
mesh_terms: D004935:Esophageal Diseases / Q000601:surgery; D004939:Esophageal Perforation / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy; D004947:Esophagus / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D011859:Radiography; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology