Approach and management modalities in Esophageal Perforations

Authors

  • Rajendra Desai Department of Surgery, Shadan Institute of Medical Sciences, Teaching Hospital and Research Centre, Himayatsagar Road, Rangareddy, Hyderabad, Telangana, India
  • Srivastava R. Department of Surgery, Shadan Institute of Medical Sciences, Teaching Hospital and Research Centre, Himayatsagar Road, Rangareddy, Hyderabad, Telangana, India
  • Chitrapu C. Department of Surgery, Shadan Institute of Medical Sciences, Teaching Hospital and Research Centre, Himayatsagar Road, Rangareddy, Hyderabad, Telangana, India
  • Mohd Kaleemuddin Department of Surgery, Shadan Institute of Medical Sciences, Teaching Hospital and Research Centre, Himayatsagar Road, Rangareddy, Hyderabad, Telangana, India
  • Chandramala Amenha Department of Surgery, Shadan Institute of Medical Sciences, Teaching Hospital and Research Centre, Himayatsagar Road, Rangareddy, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2349-2902.isj20180333

Keywords:

Esophagus, Mediastinitis, Perforation, Pediatric

Abstract

Esophageal perforation leads to increased morbidity and mortality. Treatment of choice is debatable. In adult cases of esophageal perforation, the important causes can be due to trauma, or due to foreign body or due to iatrogenic and sometimes it may be spontaneous. The rate of morbidity and mortality is increased among those who fall prey to delayed diagnosis and delayed treatment. Even after the proper treatment started within one day of diagnosis, the death rate can be 10-25%. And it increases to 40-60% among those who receive treatment after two days. In case the diagnosis of perforation is made within 24 hours, the treatment of choice is “primary closure of the perforation site and wide drainage of the mediastinum”. On the other hand, if the diagnosis is delayed for more than 24 hours, then the treatment of choice is questionable. Now a days conservative method of management is more or less adopted especially patients with small size perforation and minimum involvement of extra esophageal part. Mortality rate is determined by some factors like cause, the injury site, pre-existing disease of esophagus, treatment method used and the timing of the diagnosis. Hence multi-disciplinary approach is recommended for proper outcome. Timing of intervention is extremely critical in ensuring low mortality. Diagnosis is difficult, and a high degree of suspicion is required, especially in pediatric patients. As Endoscopic therapists play an increasingly “important role in the management of upper digestive disease”, a proper understanding of this complication of therapy is required by the therapist and the attending surgeons. Management of such perforations are both non-operative and operative. Nonoperative management used for limited perforations without sepsis, while operative management is reserved for more florid perforations and those in whom obstruction distal to the perforation exists. Endoscopic intervention may save some patients from being operated upon.

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Published

2018-01-25

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Review Articles