title: Perforations of the esophagus and stomach: what should I do?
abstract: BACKGROUND
  Esophageal and gastroduodenal perforations are relatively uncommon; however, they both can be potentially life-threatening. Esophageal perforations most commonly occur due to iatrogenic injury, forceful retching (Boerhaave's syndrome), malignancy, foreign body ingestion, or caustic injury. Gastroduodenal perforations are most commonly due to peptic ulcer disease or malignancy. Pain and signs of sepsis are the most common presenting symptoms and signs.
  
  
  METHODS
  Determining the extent of critical illness and addressing hemodynamics and sepsis are the first priorities. Identifying the location and size of the perforation as well as extent of contamination is the next priorities. Although surgical intervention has been the mainstay of treatment, newer approaches have led to a heterogeneity of approaches.
  
  
  CONCLUSIONS
  For esophageal perforation, observation, endoscopic, radiological, and surgical approaches may be appropriate. For gastroduodenal perforation, surgical approach is still the most appropriate, although a concomitant acid-reducing operation is usually not necessary. Despite these advances, mortality for both perforations can still be high. Sound judgment is necessary for optimal results.
authors.affiliation: Division of General Surgery, University of South Florida, One Tampa General Circle, F145, Tampa, FL, 33606, USA.
authors.forename: Francesca
authors.initials: F
authors.lastname: Dimou
authors.forename: Vic
authors.initials: V
authors.lastname: Velanovich
mesh_terms: D016099:Endoscopy, Gastrointestinal; D004939:Esophageal Perforation / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D010146:Pain / Q000209:etiology; D018805:Sepsis / Q000209:etiology; D013272:Stomach Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy*