Esophageal perforation: surgical outcomes in a referral center
Main Article Content
Keywords
Esophageal Perforation, Postoperative Complications, Esophageal Diseases, General Surgery, Thoracic Surgery
Abstract
Abstract
Esophageal perforation is a rare and potentially life-threatening condition. Its main etiologies include iatrogenic, traumatic, and neoplastic causes. Diagnosis is based on imaging and endoscopic studies. Although some cases can be managed conservatively, most require endoscopic or surgical interventions.
A retrospective, descriptive study was conducted analyzing the clinical characteristics, treatment, and outcomes of patients with esophageal perforation treated at a referral hospital between 2019 and 2023.
Twenty patients were included, with a mean age of 52 years and a predominance of men. The most frequent perforation sites were the cervical and abdominal regions, followed by the thoracic region. The etiology was iatrogenic in 13 cases and traumatic in 7 patients. The most common symptoms were pain, edema, and purulent drainage, and the predominant radiographic finding was contrast medium leakage. The mean time to diagnosis was 5.5 days. All patients required surgical management: primary closure in 4 cases, primary closure with jejunostomy in 5, primary closure with muscle patch in 3, and esophagectomy with esophagostomy and jejunostomy in 8 patients. The overall mortality rate was 20%.
In this series, a high proportion of late diagnoses were observed, related to the time of referral to the unit; however, all patients required surgical treatment. Despite this, the observed mortality rate was comparable to that reported in the international literature.
References
1. Axtell AL, Gaissert HA, Morse CR, et al. Management and outcomes of esophageal perforation. Dis Esophagus. 2022;35(1). Disponible en: https://doi.org/10.1093/dote/doab039.
2. Biancari F, Saarnio J, Mennander A, et al. Outcome of patients with esophageal perforations: a multicenter study. World J Surg 2014;38(4): 902–9. Disponible en: https://doi.org/10.1007/s00268-013-2312-2.
3. Shahriarirad R, Karoobi M, Shekouhi R, et al. Esophageal perforation etiology, outcome, and the role of surgical management – an 18-year experience of surgical cases in a referral center. BMC Surg. 2023;23:177. Disponible en: http://doi.org/10.1186/s12893-023-02080-w.
4. Lampridis S, Mitsos S, Hayward M, et al. The insidious presentation and challenging management of esophageal perforation following diagnostic and therapeutic interventions. J Thorac Dis. 2020;12(5):2724–34. Disponible en: http://doi.org/10.21037/jtd-19-4096.
5. Sdralis EI, Petousis S, Rashid F, et al. Epidemiology, diagnosis, and management of esophageal perforations: systematic review. Dis Esophagus. 2017;30(8):1–6. Disponible en: http://doi.org/10.1093/dote/dox013.
6. Norton‑Gregory AA, Kulkarni NM, O’Connor SD, et al. CT esophagography for evaluation of esophageal perforation. Radiographics. 2021;41(2):447–61. Disponible en: https://doi.org/10.1148/rg.2021200132.
7. Wei CJ, Levenson RB, Lee KS. Diagnostic utility of CT and fluoroscopic esophagography for suspected esophageal perforation in the emergency department. AJR Am J Roentgenol. 2020;215(3):631‑8. doi: 10.2214/AJR.19.22166.
8. Khaitan PG, Famiglietti A, Watson TJ. The Etiology, Diagnosis, and Management of Esophageal Perforation. J Gastrointest Surg. 2022;26(12):2606‑2615. Disponible en: https://doi.org/10.1007/s11605-022-05454-2.
9. Vermeulen BD, van der Leeden B, Ali JT, et al. Early diagnosis is associated with improved clinical outcomes in benign esophageal perforation: an individual patient data meta-analysis. Surg Endosc. 2021;35(7):3492–3505. Disponible en: https://doi.org/10.1007/s00464-020-07806-y.
10. DeVivo A, Sheng AY, Koyfman A, et al. High risk and low prevalence diseases: Esophageal perforation. Am J Emerg Med. 2022;53:29–36. Disponible en: https://doi.org/10.1016/j.ajem.2021.12.017.
11. Wong LY, Leipzig M, Liou DZ, et al. Surgical management of esophageal perforation: examining trends in a multi-institutional cohort. J Gastrointest Surg. 2023;27(9):1757–65. Disponible en: https://doi.org/10.1007/s11605-023-05700-1.
12. Al Jubab A, Jafarli I, Al Tokhais T. Surgical versus non‑surgical treatment for traumatic esophageal perforation in children: a systematic review. J Curr Surg. 2016;6(2):41–5. Disponible en: https://doi.org/0.14740/jcs296w.
13. Deng Y, Hou L, Qin D, et al. Current treatment and outcome of esophageal perforation: A single‑center experience and a pooled analysis. Medicine (Baltimore). 2021;100(16). Disponible en: https://doi.org/10.1097/MD.0000000000025600.
14. Puerta-Vicente A, Priego-Jiménez P, Cornejo-López MA, et al. Management of esophageal perforation: 28-year experience in a major referral center. Am Surg. 2018;84(5):684–689. Disponible en: https://doi.org/10.1177/000313481808400520.
15. Lee JH, Kedia P, Stavropoulos SN, et al. AGA clinical practice update on endoscopic management of perforations in gastrointestinal tract: expert review. Clin Gastroenterol Hepatol. 2021;19(11):2252–61. Disponible en: https://doi.org/10.1016/j.cgh.2021.06.045.
16. Gurwara S, Clayton S. Esophageal perforations: an endoscopic approach to management. Curr Gastroenterol Rep. 2019;21(11):57. Disponible en: https://doi.org/10.1007/s11894-019-0730-5.
17. Stathopoulos P, Zumblick M, Wächter S, et al. Endoscopic vacuum therapy (EVT) for acute esophageal perforation: Could it replace surgery? Endoscopy International Open. 2022;10(05):686-693. Disponible en: https://doi.org/10.1055/a-1781-0827
18. Mandarino FV, Fanti L, Barchi A, et al. Endoscopic vacuum therapy for esophageal perforations: is it risk effective for every size of defect? Endoscopy. 2023;55(10):971. Disponible en: https://doi.org/10.1055/a-2070-5524.
19. Luttikhold J, Pattynama L M, Seewald S, et al. Endoscopic vacuum therapy for esophageal perforation: a multicenter retrospective cohort study. Endoscopy 2023;55(09): 859-864. Disponible en: https://doi.org/10.1055/a-2042-6707.
20. Liao F, Zhu Z, Pan X, et al. Safety and efficacy of nonoperative treatment in esophageal perforation caused by foreign bodies. Clin Transl Gastroenterol. 2022;13(1). Disponible en: https://doi.org/10.14309/ctg.0000000000000451.
21. Kim JD. Prognostic factors of esophageal perforation and rupture leading to mortality: a retrospective study. J Cardiothorac Surg. 2021;16(1):291. Disponible en: https://doi.org/10.1186/s13019-021-01680-y.
22. Hernández Ortiz JR, Leonher Ruezga KL, Ramírez González LR, et al. Manejo de perforación esofágica en un centro de concentración. Doce años de experiencia. Rev Latinoam Cir. 2014;4(1).
23. García-Moreno V, Maiocchi K, Gómez-Quiles L, et al. Tratamiento de la perforación de esófago: revisión de nuestra experiencia en un hospital de tercer nivel en los últimos 19 años. Rev Gastroenterol Mex. 2022;87(4):405–410. Disponible en: https://doi.org/10.1016/j.rgmx.2021.02.009.
24. Schweigert M, Santos Sousa H, Solymosi N, et al. Spotlight on esophageal perforation: A multinational study using the Pittsburgh esophageal perforation severity scoring system. J Thorac Cardiovasc Surg. 2016;151(4):1002–11. Disponible en: https://doi.org/10.1016/j.jtcvs.2015.11.055.
25. Veziant J, Boudis F, Lenne X, et al. Outcomes associated with esophageal perforation management: results from a French nationwide population-based cohort study. Ann Surg. 2023;278(5):709–716. Disponible en: https://doi.org/10.1097/SLA.0000000000006048
26. Shaqran TM, Engineer R, Abdalla EM et al. The Management of Esophageal Perforation: A Systematic Review. Cureus. 2024;16(7). https://doi.org/10.7759/cureus.63651.
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