title: Esophageal perforation: clinical patterns and outcomes from a patient cohort of Western Norway.
abstract: BACKGROUND
  Esophageal perforation is a rare, often life-threatening condition, and management remains challenging.
  
  
  METHODS
  Retrospective review of consecutive patients with esophageal perforation treated at two university hospitals between 2000 and 2010. Pertinent data from hospital records were retrieved for statistical calculations and evaluation of perforation score.
  
  
  RESULTS
  Forty-seven patients [47% female, median age 62 years (range 15-88)] were included. The annual incidence was 4.7/1,000,000. Perforations were spontaneous in 14 patients (30%), iatrogenic in 25 (53%), and caused by trauma and foreign body impaction in 8 patients (17%). ASA score (p = 0.004), perforation localization (p = 0.001), diagnostic delay (p = 0.002), and perforation score (p < 0.001) differed significantly between patient groups with different etiology, but not between groups with different outcomes. Early diagnosis (≤24 h) was significantly associated with a low perforation score (p = 0.033). A non-operative approach was employed in 26 patients (55%) - more commonly for proximally localized perforations (p = 0.045). The non-operative group showed lower severe complication rates (p = 0.033), shorter ICU stays (p < 0.001) and durations of mechanical ventilation (p = 0.022). The overall 30-day mortality was 23.4%.
  
  
  CONCLUSIONS
  Careful clinical evaluation and appropriate, individualized treatment are important. The high mortality may be partly explained by the underlying disease and the complexity of the clinical condition in many patients.
authors: Department of Gastroenterologic Surgery, Stavanger University Hospital, Stavanger, Norway. jon.soreide@kir.uib.no
authors: Jon Arne
authors: JA
authors: Søreide
authors: Andri
authors: A
authors: Konradsson
authors: Oddvar M
authors: OM
authors: Sandvik
authors: Kjell
authors: K
authors: Øvrebø
authors: Asgaut
authors: A
authors: Viste
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D042241:Early Diagnosis; D004939:Esophageal Perforation / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult