Treatment of perforation in the healthy esophagus: analysis of 12 cases |
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Authors: | Vittorio Bresadola Giovanni Terrosu Alessandro Favero Federico Cattin Vittorio Cherchi Gian Luigi Adani Maria Grazia Marcellino Fabrizio Bresadola Dino De Anna |
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Institution: | (1) Department of Surgery, University Hospital Udine, Udine, Italy;(2) Clinica di Chirurgia Generale, Policlinico Universitario, P.le S.M. della Misericordia 15, Pad. Petracco, 33100 Udine, Italy |
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Abstract: | Background Perforation of the esophagus still carries high morbidity and mortality rates, and there is no gold standard for the surgical
treatment of choice.
Materials and methods We reviewed the records of patients treated for esophageal perforation in the last decade at the General Surgery Unit of the
University of Udine. Patients suffering from perforation secondary to surgical procedures or neoplastic disease were ruled
out.
Results Eight males (66.7%) and four females (33.3%) met the inclusion criteria. The cause of perforation was iatrogenic in seven
cases (58.3%) and spontaneous in five (41.7%). The perforation was in the cervical esophagus in five cases (41.7%) and at
thoracic level in the other seven (58.3%). Two patients (16.7%) with cervical lesions were treated conservatively; two (16.7%)
underwent primary closure and the insertion of a drainage tube; one patient with a distal cervical lesion underwent diversion
esophagostomy; six patients had resection of the entire thoracic esophagus and terminal cervical esophagostomy; one had segmental
resection of the distal thoracic esophagus and lateral diversion esophagostomy. In the five patients whose reconstruction
was postponed, esophagogastroplasty surgery was performed with an anastomosis at cervical level in four cases and at thoracic
level in one. The global mortality rate was 25%. Late diagnosis—more than 24 h after the perforation event—seems to be the
only factor correlated with fatal outcome (p = 0.045).
Conclusions The choice of treatment for perforation in a healthy esophagus depends mainly on the site and size of the lesion. Cervical
lesions may be amenable to conservative treatment or require primary surgical repair, while thoracic lesions with associated
sepsis or major loss of substance demand an aggressive approach, with esophageal resection and delayed reconstruction seeming
to be the safest option. |
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Keywords: | Esophagus Esophageal perforation Esophageal rupture Treatment Surgery |
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