Esophageal perforation--the problems of late presentation.
OBJECTIVE
Esophageal perforation is an uncommon and difficult problem. Delay in diagnosis and appropriate treatment often results in a high morbidity and mortality. Along with the duration after the perforation, several other factors determine the outcome in these patients. The presentation, treatment and outcome of these patients have not been discussed adequately in recent literature.


METHODS
We analyzed all the patients of esophageal perforation managed by us with respect to their presentation, treatment and outcome.


RESULTS
We have managed 52 patients of esophageal perforation. The commonest cause was iatrogenic injury (50%). Thirty-two (61%) patients presented >2 days after the perforation. Twenty-two patients (42%) underwent esophageal exclusion and diversion procedures, 25 underwent other procedures and 5 were managed conservatively. Major morbidity (mainly pulmonary) was seen in 61% patients and the overall mortality was 17%. There was no mortality in patients who presented early (<2 days). Mortality was associated with late presentation beyond 2 days, low serum albumin (< 3 g/dl) and the requirement of perioperative mechanical ventilation.


CONCLUSIONS
Esophageal perforation (especially late presentation) results in a high morbidity and mortality. Esophageal exclusion and diversion is a useful temporizing measure in these very sick patients. Prompt recognition, early referral and proper management of esophageal perforation are needed in order to decrease the mortality and morbidity.
Singh
Rajineesh Kumar
RK
Dept of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences Lucknow, UP, India. rajneeshkumarsingh@hotmail.com
Sahni
Peush
P
Chattopadhyay
Tushar K
TK
D000328:Adult; D002423:Cause of Death; D002637:Chest Pain / Q000209:etiology; D004939:Esophageal Perforation / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D018805:Sepsis / Q000209:etiology