Esophageal Perforation

Česká verzia

Authors: A. Pazdro; T. Haruštiak; M. Šnajdauf; M. Smejkal; J. Schützner; P. Pafko; J. Tvrdoň; R. Lischke
Authors place of work: III. chirurgická klinika FN Praha-Motol, přednosta: doc. MUDr. R. Lischke, Ph. D.
Published in the journal: Rozhl. Chir., 2011, roč. 90, č. 11, s. 647-652.
Category: Monothematic special - Original

Summary

Objective:
Evaluation of patients with acute esophageal perforations with single institution experience.

Material and methods:
The authors evaluate the set of 64 consecutive patients with esophageal perforation treated in our department between January 2000 and December 2010. In all patients were before decision making performed CT scans and X-ray examination with contrast agent administration. For selected patients was also accompanied upper endoscopy. Excluded were patients with malignant tracheoesophageal fistula and patients with perforation of malignant stenosis treated with palliative intent.

Results:
The mean age was 62 years (range 24–90), of which one third (34.4%) were aged 70 years or more. We received the iatrogenic perforation in 45 (70%) patients, less than one quarter (n = 15; 23%) consisted of spontaneous perforation, in three patients we have failed to determine the cause of perforation (5%) and one patient experienced perforation during removal of foreign body. Perforation of the thoracic esophagus in 41 patients, in 20 (31%) cases in the upper and middle third and 21 (33%) in the distal third of the thoracic esophagus. Cervical perforation was noted in 14 patients (22%) and abdominal of the 9 patients (14%). 92% of patients were treated surgically (n = 59). 43% (n = 27) were treated by primary suture of the perforation, esophageal resection with primary reconstruction was performed in 4 patients, esophagectomy with terminal esophagostomy and nutritional jejunostomy in 7 patients, 4 patients were treated by surgical drainage and only 7 patients, we introduced endless lavage. In 9 cases we have resected affected portion of esophagus with stapler closure in the chest. Conservative management of esophageal perforation we proceeded in 5 patients in whom a stent was introduced and the perforation successfully healed. Overall mortality in our set of patients is 23.4%.

Conclusion:
Conservative procedure in carefully selected patients could be an alternative to radical and inherently surgical procedures Published results and our little experience are encouraging, but this topic is still under study.

Key words:
esophageal perforation

Zdroje

1. Abbas, G., Schuchert, M. J., Pettiford, B. L., Pennathur, A., Landreneau, J., Luketich, J. D., et al. Contemporaneous management of esophageal perforation. Surgery, 2009; 146(4): 749–755 [discussion 55–56]

2. Altorjay, A., Kiss, J., Voros, A., Bohak, A. Nonoperative management of esophageal perforations. Is it justified? Ann. Surg., 1997; 225(4): 415–421.

3. Brinster, C. J., Singhal, S., Lee, L., Marshall, M. B., Kaiser, L. R., Kucharczuk, J. C. Evolving options in the management of esophageal perforation. Ann. Thorac. Surg., 2004; 77(4): 1475–1483.

4. Campos, G. M., Vittinghoff, E., Rabl, C., Takata, M., Gadenstatter, M., Lin, F., et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann. Surg., 2009; 249(1): 45–57.

5. de Dominici, F., Rekik, R., Merlusca, G., Deguines, J. B., Gamain, J., Berna, P. Perforation par sonde nasogastrique avec arc aortique droit et aorte descendante ą droite. J. Chir., 2009; 146: 499–502.

6. de Lutio di Castelguidone, E., Merola, S., Pinto, A., Raissaki, M., Gagliardi, N., Romano, L. Esophageal injuries: spectrum of multidetector row CT findings. Eur. J. Radiol., 2006; 59(3): 344–348.

7. Fischer, A., Thomusch, O., Benz, S., von Dobschuetz, E., Baier, P., Hopt, U. T. Nonoperative treatment of 15 benign esophageal perforations with self-expandable covered metal stents. Ann. Thorac. Surg., 2006; 81(2): 467–472.

8. Foley, M. J., Ghahremani, G. G., Rogers, L. F. Reappraisal of contrast media used to detect upper gastrointestinal perforations: comparison of ionic water-soluble media with barium sulfate. Radiology, 1982; 144: 231–237.

9. Gelbmann, C. M., Ratiu, N. L., Rath, H. C., Rogler, G., Lock, G., Scholmerich, J., et al. Use of self-expandable plastic stents for the treatment of esophageal perforations and symptomatic anastomotic leaks. Endoscopy, 2004; 36(8): 695–699.

10. Gollub, M. J., Bains, M. S. Barium sulfate: a new (old) contrast agent for diagnosis of postoperative esophageal leaks. Radiology, 1997; 202: 360–362.

11. Griffiths, E. A., Yap, N., Poulter, J., Hendrickse, M. T., Khurshid, M. Thirty-four cases of esophageal perforation: the experience of a district general hospital in the UK. Dis. Esophagus, 2009; 22(7): 616–625.

12. Gupta, N. M., Kaman, L. Personal management of 57 consecutive patients with esophageal perforation. Am. J. Surg., 2004; 187(1): 58–63.

13. Horwitz, B., Krevsky, B., Buckman, Jr. R. F, Fisher, R. S., Dabezies, M. A. Endoscopic evaluation of penetrating esophageal injuries. Am. J. Gastroenterol., 1993; 88(8): 1249–1253.

14. Chirica, M., Champaulta, A., Drayb, X., Sulpicec, L., Munoz-Bongranda, N., Sarfati, E., Cattana, P. Esophageal perforations. Journal of Visceral Surgery, (2010) 147, e117–e128.

15. Jougon, J., Cantini, O., Delcambre, F., Mihnuti, A., Velly, J. F. Esophageal perforation: life threatening complication of endotracheal intubation. Eur. J. Cardiothorac. Surg., 2001; 20(1): 7–10 [discussion 11].

16. Kavic, S. M., Basson, M. D. Complications of endoscopy. Am. J. Surg., 2001; 181(4): 319–332.

17. Kim, A. W., Liptay, M. J., Snow, N., Donahue, P., Warren, W. H. Utility of silicone esophageal bypass stents in the management of delayed complex esophageal disruptions. Ann. Thorac. Surg., 2008; 85(6): 1962–1967 [discussion 7].

18. Korn, O., Onate, J. C., Lopez, R. Anatomy of the Boerhaave syndrome. Surgery, 2007; 141(2): 222–228.

19. Kuppusamy, M. K., Hubka, M., Felisky, C. D., Carrott, P., Kline, E. M., Koehler, R. P., Low, D. E. Evolving management strategies in esophageal perforation: surgeons using nonoperative techniques to improve outcomes. J. Am. Coll. Surg., 2011 Jul; 213(1): 164–171; discussion 171–172. Epub 2011 Mar 23.

20. Lee, J. G., Lieberman, D. A. Complications related to endoscopic hemostasis techniques. Gastrointest. Endosc. Clin. N. Am., 1996; 6(2): 305–321.

21. Minnich, D. J., Yu, P., Bryant, A. S., Jarrar, D., Cerfolio, R. J. Management of thoracic esophageal perforations. Eur. J. Cardiothorac. Surg., 2011 Oct; 40(4): 931–937. Epub 2011 Feb 25.

22. Morgan, R. A., Ellul, J. P., Denton, E. R., Glynos, M., Mason, R. C., Adam, A. Malignant esophageal fistulas and perforations: management with plastic-covered metallic endoprostheses. Radiology, 1997; 204(2): 527–532.

23. Orringer, M. B., Stirling, M. C. Esophagectomy for esophageal disruption. Ann. Thorac. Surg., 1990; 49(1): 35–42 [discussion 43].

24. Salminen, P., Gullichsen, R., Laine, S. Use of self-expandable metal stents for the treatment of esophageal perforations and anastomotic leaks. Surg. Endosc., 2009; 23(7): 1526–1530.

25. Sawyer, R., Phillips, C., Vakil, N. Short- and long-term outcome of esophageal perforation. Gastrointest. Endosc., 1995; 41: 130–134.

26. Sepesi, B., Raymond, D. P., Peters, J. H. Esophageal perforation: surgical, endoscopic and medical management strategies. Curr. Opin. Gastroenterol., 2010 Jul; 26(4): 379–383.

27. Shaffer, H. A. Jr., Valenzuela, G., Mittal, R. K. Esophageal perforation. A reassessment of the criteria for choosing medical or surgical therapy. Arch. Intern. Med., 1992; 152: 757–761.

28. Sung, S. W., Park, J. J., Kim, Y. T., Kim, J. H. Surgery in thoracic esophageal perforation: primary repair is feasible. Dis. Esophagus, 2002; 15(3): 204–209.

29. Urschel, Jr. H. C., Razzuk, M. A., Wood, R. E., Galbraith, N., Pockey, M., Paulson, D. L. Improved management of esophageal perforation: exclusion and diversion in continuity. Ann. Surg., 1974; 179(5): 587–591.

30. Venuta, F., Rendina, E. A., De Giacomo, T., Ciccone, A. M., Mercadante, E., Coloni, G. F. Esophageal perforation after sequential double-lung transplantation. Chest, 2000; 117: 285–287.

31. Vrouenraets, B. C., Been, H. D., Brouwer-Mladin, R., Bruno, M., van Lanschot, J. J. Esophageal perforation associated with cervical spine surgery: report of two cases and review of the literature. Dig. Surg., 2004; 21(3): 246–249.

32. White, R. K., Morris, D. M. Diagnosis and management of esophageal perforations. Am. Surg., 1992 Feb; 58(2): 112–119.