title: Thirty-four cases of esophageal perforation: the experience of a district general hospital in the UK.
abstract: Esophageal perforation is uncommon and traditionally has a high rate of morbidity and mortality. Our aim was to perform a 13-year retrospective review of the cases managed in our district general hospital. Thirty-four cases of esophageal perforation diagnosed between 1995 and 2008 were retrospectively analyzed. There were 20 males and 14 females with a median age of 64 (range 23-86) years. The etiology of the perforations were Boerhaave's syndrome (n= 19), therapeutic endoscopy (n= 9), diagnostic endoscopy (n= 2), gastric lavage injury (n= 1), foreign body (n= 1), blunt chest trauma (n= 1), and spontaneous tumor perforation (n= 1). Only 11 cases (32%) had evidence of surgical emphysema upon examination. In 50% of cases, another clinical diagnosis was initially suspected. Twenty-four were treated surgically and 10 cases managed non-operatively. Surgical treatment included thoracotomy with primary repair (n= 9), T-tube drainage (n= 7), emergency esophagectomy (n= 1), or intra-operative stent insertion (n= 1). Four cases had primary repair and fundal wrap via abdominal approach without thoracotomy. Two patients were treated with washout and drainage only. Eight patients died overall (in-hospital mortality 23.5%). Esophageal perforations are often initially misdiagnosed and the majority do not have surgical emphysema. There are a wide variety of methods to manage esophageal perforation. Management tailored to the location and size of perforation, degree of contamination, and underlying cause appears to result in a reasonable prognosis.
authors.affiliation: Department of General Surgery, Furness General Hospital, Barrow in Furness, Cumbria, UK. eagriffiths@btinternet.com
authors.forename: E A
authors.initials: EA
authors.lastname: Griffiths
authors.forename: N
authors.initials: N
authors.lastname: Yap
authors.forename: J
authors.initials: J
authors.lastname: Poulter
authors.forename: M T
authors.initials: MT
authors.lastname: Hendrickse
authors.forename: M
authors.initials: M
authors.lastname: Khurshid
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal; D004939:Esophageal Perforation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D013908:Thoracotomy; D006113:United Kingdom; D055815:Young Adult