Injuries and perforated esophagus
A ten-year-experience
Keywords:
ESOPHAGOPATHIES, PERFORATION OF THE ESOPHAGUS, SPONTANEOUS BREAKAGE
Abstract
Introduction: esophageal injuries have high mortality and a controversial treatment. Diagnosis and treatment of esophageal injuries are under discussion because they are not frequent. The purpose of this paper is to show results and treatment from our series.
Methods: Twenty patients with perforated esophagus were retrospectively analyzed, excluding tracheo-esophageal fistula, neonatal spontaneous perforations and suture fails. We studied mortality related to clinical presentation, progression time and treatment.
Results: The most frequent causes of the series were the instrumental (35%) and the spontaneous injuries (30%). Chest pain, pleural spilling and temperature were the most constant symptoms. Primary suture, with or without stress was the most used therapeutic procedure. Overall mortality was 40%.
Conclusions: Treatment must be adequate to each patient and situation, medical treatment should be performed in selected cases. Clinical presentation has an important prognostic value.
References
1) Gouge TH, Depan HJ, Spencer FC. Experience with the Grillo pleural wrap procedure in 18 patients with perforation of the thoracic esophagus. Ann Surg 1989; 209(5): 612-7.
2) Goldstein LA, Thompson WR. Esophageal perforations: a 15 year experience. Am J Surg 1982; 143(4): 495-503.
3) Ruso L, González F, Bogliaccini G, Morelli R. Rotura espontánea de esófago: cuatro observaciones. Cir Urug 1991; 61(1/2): 60-3.
4) Lawrence DR, Ohri SK, Moxon RE, Townsend ER, Fountain SW. Primary esophageal repair for Boerhaave’s syndrome. Ann Thorac Surg 1999; 67(3): 818-20.
5) Wang N, Razzouk AJ, Safavi A, Gan K, Van-Arsdell GS, Burton PM, et al. Delayed primary repair of intrathoracic esophageal perforation: is it safe? J Thorac Cardiovasc Surg 1996; 111(1): 114-22.
6) Abbott OA, Mansour KA, Logan WD Jr, Hatcher CR Jr, Symbas PN. Atraumatic so- called "spontaneous" rupture of the esophagus. J Thorac Cardiovasc Surg 1970; 59(1): 67-83.
7) Tilanus HW, Bossuyt P, Schattenkerk ME, Obertop H. Treatment of oesophageal perforation: a multivariate analysis. Br J Surg 1991; 78(5): 582-5.
8) Giudicelli R. Les perforations de l’œsophage. Résultats d’une enquesta nationale. Ann Chir 1992; 46(2): 183-7.
9) Jones WG 2nd, Ginsberg RJ. Esophageal perforation: continuing challenge. Ann Thorac Surg 1992; 53(3): 534-43.
10) Schauer PR, Meyers WC, Eubanks S, Norem RF, Franklin M, Pappas TN. Mechanisms of gastric and esophageal perforations during laparoscopic Nissen fundoplication. Ann Surg 1996; 223(1): 43-52.
11) Richelme H, Bourgeon A, Ferrari C, Michels-Galy M. Quatre observations de rupture spontanée de l’œsophage: déductions diagnostiques et thérapeutiques de l’analyse détailée de cent observations completes publiées dans la littérature. Chirurgie 1981; 107(2): 158-69.
12) Symbas PN, Hatcher CR Jr, Harlaftis N. Spontaneous rupture of the esophagus. Ann Surg 1978; 187(6): 634-40.
13) Van-de-Louw A, Brocas E, Boiteau R, Perrin-Gachadoat D, Tenaillon A. Esophageal perforation associated with noninvasive ventilation: a case report. Chest 2002; 122(5): 1857-8.
14) Urschel HC Jr, Razzuk MA, Wood RE, Galbraith N, Pockey M, Paulson DL. Improved management of esophageal perforation: exclusion and diversion in continuity. Ann Surg 1974; 179(5): 587-91.
15) Banks JG, Bancewicz J. Perforation of the esophagus: experience in a general hospital. Br J Surg 1981; 68(8): 580-4.
16) Walker WS, Cameron EW, Walbaum PR. Diagnosis and management of spontaneous transmural rupture of the esophagus (Boerhaave’s syndrome). Br J Surg 1985; 72(3): 204-7.
17) Girones-Vila J, Sebastian-Quetglas F, Roig-García JM, Farrés-Coll R, Rodríguez-Hermosa JI, Tuca-Rodríguez F, et al. Perforaciones esofágicas torácicas: Tratamiento quirúrgico mediante exclusión mecánica bipolar. Rev Esp Enferm Dig 1999; 91(3): 190-4.
18) Backer CL, LoCicero J, Hartz RS, Donaldson JS, Shields T. Computed tomography in patients with esophageal perforation. Chest 1990; 98(5): 1078-80.
19) Cameron JL, Kieffer RF, Hendrix TR, Mehigan DG, Robinson R. Selective nonoperative management of contained intrathoracic esophageal disruptions. Ann Thorac Surg 1979; 27(5): 404-8.
20) Gayet B, Perniceni T, Boudet MJ. Résultats de l’enquete de l’Association francaise de chirurgie, analyse multivariée. In: Célérier M, Gayet B. eds. Les traumatismes de l’œsophage. Paris: Annette Blackwell, 1995: 79-110.
21) Platel JP, Thomas P, Giudicelli R, Lecuyer J, Giacoia A, Fuentes P. Perforations et ruptures oesophagiennes: plaidoyer pour traitement conservateur. Ann Chir 1997; 51(6): 611-6.
22) Skinner DB, Little AG, DeMeester TR. Management of esophageal perforations. Am J Surg 1980; 139(6): 760-4.
23) Brewer LA 3rd, Carter R, Mulder GA, Stiles QR. Options in the management of perforations of the esophagus. Am J Surg 1986; 152(1): 62-9.
24) White RK, Morris DM. Diagnosis and management of esophageal perforations. Am Surg 1992; 58(2): 112-9.
25) Bufkin BL, Miller JI Jr, Mansour KA. Esophageal perforation: emphasis on management. Ann Thorac Surg 1996; 61(5): 1447-51; discussion 1451-2.
26) Rios-Zambudio A, Martínez-de-Haro LF, Ortiz-Escandell MA, Durán H, Munitiz-Ruiz V, Parrilla-Paricio P. Perforaciones esofágicas: Presentación de 23 casos. Gastroenterol Hepatol 2000; 23(8): 379-83.
27) Naylor AR, Walker WS, Dark J, Cameron EW. T-tube intubation in the management of seriously ill patients with oesophagopleural fistulae. Br J Surg 1990; 77(1): 40-2.
28) Orringer MB, Stirling MC. Esophagectomy for esophageal disruption. Ann Thorac Surg 1990; 49(1): 35-43.
29) Richardson JD, Martin LF, Borzotta AP, Polk HC Jr. Unifying concepts in treatment of esophageal leaks. Am J Surg 1985; 149(1): 157-62.
30) Brichon PY, Couraud L, Velly JF, Martigne C, Clerc F. Les perforations et ruptures de l’œsophage: a propos de trente-cinq cas. Ann Chir 1990; 44(6): 464-70.
31) Bladergroen MR, Lowe JE, Postlethwait RW. Diagnosis and recommended management of esophageal perforation and rupture. Ann Thorac Surg 1986; 42(3): 235-9.
32) Attar S, Hankins JR, Suter CM, Coughlin TR, Sequeira A, McLaughlin JS. Esophageal perforation: a therapeutic challenge. Ann Thorac Surg 1990; 50(1): 45-51.
33) Wright CD, Mathisen DJ, Wain JC, Moncure AC, Hilgenberg AD, Grillo HC. Reinforced primary repair of thoracic esophageal perforation. Ann Thorac Surg 1995; 60(2): 245-9.
34) Michel L, Grillo HC, Malt RA. Operative and nonoperative management of esophageal perforations. Ann Surg 1981; 194(1): 57-63.
35) Gayet B. Perforations de l’œsophage. Actual Dig 1987; 9: 52-3.
36) Jougon J, Delcambre F, MacBride T, Minniti A, Velly JF. La mortalité des perforations de l’esophage est elevée: expérience de 54 cas traités. Ann Chir 2002; 127(1): 26-31.
2) Goldstein LA, Thompson WR. Esophageal perforations: a 15 year experience. Am J Surg 1982; 143(4): 495-503.
3) Ruso L, González F, Bogliaccini G, Morelli R. Rotura espontánea de esófago: cuatro observaciones. Cir Urug 1991; 61(1/2): 60-3.
4) Lawrence DR, Ohri SK, Moxon RE, Townsend ER, Fountain SW. Primary esophageal repair for Boerhaave’s syndrome. Ann Thorac Surg 1999; 67(3): 818-20.
5) Wang N, Razzouk AJ, Safavi A, Gan K, Van-Arsdell GS, Burton PM, et al. Delayed primary repair of intrathoracic esophageal perforation: is it safe? J Thorac Cardiovasc Surg 1996; 111(1): 114-22.
6) Abbott OA, Mansour KA, Logan WD Jr, Hatcher CR Jr, Symbas PN. Atraumatic so- called "spontaneous" rupture of the esophagus. J Thorac Cardiovasc Surg 1970; 59(1): 67-83.
7) Tilanus HW, Bossuyt P, Schattenkerk ME, Obertop H. Treatment of oesophageal perforation: a multivariate analysis. Br J Surg 1991; 78(5): 582-5.
8) Giudicelli R. Les perforations de l’œsophage. Résultats d’une enquesta nationale. Ann Chir 1992; 46(2): 183-7.
9) Jones WG 2nd, Ginsberg RJ. Esophageal perforation: continuing challenge. Ann Thorac Surg 1992; 53(3): 534-43.
10) Schauer PR, Meyers WC, Eubanks S, Norem RF, Franklin M, Pappas TN. Mechanisms of gastric and esophageal perforations during laparoscopic Nissen fundoplication. Ann Surg 1996; 223(1): 43-52.
11) Richelme H, Bourgeon A, Ferrari C, Michels-Galy M. Quatre observations de rupture spontanée de l’œsophage: déductions diagnostiques et thérapeutiques de l’analyse détailée de cent observations completes publiées dans la littérature. Chirurgie 1981; 107(2): 158-69.
12) Symbas PN, Hatcher CR Jr, Harlaftis N. Spontaneous rupture of the esophagus. Ann Surg 1978; 187(6): 634-40.
13) Van-de-Louw A, Brocas E, Boiteau R, Perrin-Gachadoat D, Tenaillon A. Esophageal perforation associated with noninvasive ventilation: a case report. Chest 2002; 122(5): 1857-8.
14) Urschel HC Jr, Razzuk MA, Wood RE, Galbraith N, Pockey M, Paulson DL. Improved management of esophageal perforation: exclusion and diversion in continuity. Ann Surg 1974; 179(5): 587-91.
15) Banks JG, Bancewicz J. Perforation of the esophagus: experience in a general hospital. Br J Surg 1981; 68(8): 580-4.
16) Walker WS, Cameron EW, Walbaum PR. Diagnosis and management of spontaneous transmural rupture of the esophagus (Boerhaave’s syndrome). Br J Surg 1985; 72(3): 204-7.
17) Girones-Vila J, Sebastian-Quetglas F, Roig-García JM, Farrés-Coll R, Rodríguez-Hermosa JI, Tuca-Rodríguez F, et al. Perforaciones esofágicas torácicas: Tratamiento quirúrgico mediante exclusión mecánica bipolar. Rev Esp Enferm Dig 1999; 91(3): 190-4.
18) Backer CL, LoCicero J, Hartz RS, Donaldson JS, Shields T. Computed tomography in patients with esophageal perforation. Chest 1990; 98(5): 1078-80.
19) Cameron JL, Kieffer RF, Hendrix TR, Mehigan DG, Robinson R. Selective nonoperative management of contained intrathoracic esophageal disruptions. Ann Thorac Surg 1979; 27(5): 404-8.
20) Gayet B, Perniceni T, Boudet MJ. Résultats de l’enquete de l’Association francaise de chirurgie, analyse multivariée. In: Célérier M, Gayet B. eds. Les traumatismes de l’œsophage. Paris: Annette Blackwell, 1995: 79-110.
21) Platel JP, Thomas P, Giudicelli R, Lecuyer J, Giacoia A, Fuentes P. Perforations et ruptures oesophagiennes: plaidoyer pour traitement conservateur. Ann Chir 1997; 51(6): 611-6.
22) Skinner DB, Little AG, DeMeester TR. Management of esophageal perforations. Am J Surg 1980; 139(6): 760-4.
23) Brewer LA 3rd, Carter R, Mulder GA, Stiles QR. Options in the management of perforations of the esophagus. Am J Surg 1986; 152(1): 62-9.
24) White RK, Morris DM. Diagnosis and management of esophageal perforations. Am Surg 1992; 58(2): 112-9.
25) Bufkin BL, Miller JI Jr, Mansour KA. Esophageal perforation: emphasis on management. Ann Thorac Surg 1996; 61(5): 1447-51; discussion 1451-2.
26) Rios-Zambudio A, Martínez-de-Haro LF, Ortiz-Escandell MA, Durán H, Munitiz-Ruiz V, Parrilla-Paricio P. Perforaciones esofágicas: Presentación de 23 casos. Gastroenterol Hepatol 2000; 23(8): 379-83.
27) Naylor AR, Walker WS, Dark J, Cameron EW. T-tube intubation in the management of seriously ill patients with oesophagopleural fistulae. Br J Surg 1990; 77(1): 40-2.
28) Orringer MB, Stirling MC. Esophagectomy for esophageal disruption. Ann Thorac Surg 1990; 49(1): 35-43.
29) Richardson JD, Martin LF, Borzotta AP, Polk HC Jr. Unifying concepts in treatment of esophageal leaks. Am J Surg 1985; 149(1): 157-62.
30) Brichon PY, Couraud L, Velly JF, Martigne C, Clerc F. Les perforations et ruptures de l’œsophage: a propos de trente-cinq cas. Ann Chir 1990; 44(6): 464-70.
31) Bladergroen MR, Lowe JE, Postlethwait RW. Diagnosis and recommended management of esophageal perforation and rupture. Ann Thorac Surg 1986; 42(3): 235-9.
32) Attar S, Hankins JR, Suter CM, Coughlin TR, Sequeira A, McLaughlin JS. Esophageal perforation: a therapeutic challenge. Ann Thorac Surg 1990; 50(1): 45-51.
33) Wright CD, Mathisen DJ, Wain JC, Moncure AC, Hilgenberg AD, Grillo HC. Reinforced primary repair of thoracic esophageal perforation. Ann Thorac Surg 1995; 60(2): 245-9.
34) Michel L, Grillo HC, Malt RA. Operative and nonoperative management of esophageal perforations. Ann Surg 1981; 194(1): 57-63.
35) Gayet B. Perforations de l’œsophage. Actual Dig 1987; 9: 52-3.
36) Jougon J, Delcambre F, MacBride T, Minniti A, Velly JF. La mortalité des perforations de l’esophage est elevée: expérience de 54 cas traités. Ann Chir 2002; 127(1): 26-31.
Published
2005-12-30
How to Cite
1.
Pomi J, Rappa J, Rodríguez Goñi P, Brandolino M. Injuries and perforated esophagus. Rev. Méd. Urug. [Internet]. 2005Dec.30 [cited 2024Nov.17];21(4):308-13. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/795
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Original Articles
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