Esophageal Perforation Management: A Single-Center Experience


Background: Esophageal perforation is a rare and potentially life-threatening condition requiring urgent management. Successful therapy depends on the underlying etiology, clinical presentation, the time between rupture and diagnosis, the extent of the rupture and the underlying health of the patient. Method: From 2005 to 2012, the author retrospectively analyzed 36 patients treated for esophageal perforation. Data were evaluated for cause of perforation, symptoms, comorbidities, the method of diagnosis, delay in diagnosis, therapeutic regimen, complications, hospital stay, follow-up and mortality. Results: The cause of perforation were iatrogenic in 14 cases (38.8%), foreign body ingestion in 11 (30.5%), spontaneous in 9 (25%), chest trauma in 1 (2.8%) and esophageal cancer in 1 case (2.8%). The most frequent signs and symptoms were chest pain in 27 cases (75%), fever in 15 (41.6%), dysphagia in 11 (30.5%), mediastinitis in 9 (25%) and vomiting in 8 (22%). The treatment included surgery in 26 cases (72.2%) which consists of thoracotomy (right or left), with or without esophageal suturing, washing, drainage with three chest tubes, jejunostomy and gastrostomy. The second group were patients treated medically in 10 cases (27.8%), medical treatment includes nil per os (NPO), parenteral nutrition, intravenous antibiotics and observation. Complications include fever (n = 14), auricular fibrillation (n = 7), esophageal fistula (n = 3), reoperation (n = 2), renal failure (n = 2), cerebrovascular accident (n = 1), pulmonary embolism (n = 1), pneumonia (n = 1) and deep vein thrombosis (n = 1). The average hospital stay for patients treated surgically was 36 days and for patients treated medically was 14.2 days. The overall mortality was 25% involving 8 patients treated surgically and 1 patient treated medically. Conclusion: The treatment method still must be chosen on an individual basis. Rapid diagnosis of this often life threatening condition is critical for expediting the choice of an optimal treatment strategy, whether surgical or non-surgical.

Share and Cite:

R. Addas, J. Berjaud, C. Renaud, P. Berthoumieu, M. Dahan and L. Brouchet, "Esophageal Perforation Management: A Single-Center Experience," Open Journal of Thoracic Surgery, Vol. 2 No. 4, 2012, pp. 111-117. doi: 10.4236/ojts.2012.24023.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] K. K. Sng, A. J. Koh, N. C. Tan, S. M. Tan and K. H. Tay, “An Eastern Perspective on Oesophageal Perforation: A High Incidence of Ingested Bones,” ANZ Journal of Surgery, Vol. 78, No. 7, 2008, 573-578. doi:10.1111/j.1445-2197.2008.04575.x
[2] P. Ryom, J. B. Ravn, L. Penninga, S. Schmidt, M. G. Iversen, P. Skov-Olsen and H. Kehlet, “Aetiology, Treatment and Mortality after Oesophageal Perforation in Denmark,” Danish Medical Bulletin, Vol. 58, No. 5, 2011, p. A4267.
[3] P. Bhatia, D. Fortin, R. I. Inculet and R. A. Malthaner, “Current Concepts in the Management of Esophageal Perforations: A Twenty-Seven Year Canadian Experience,” The Annals of Thoracic Surgery, Vol. 92, No. 1, 2011, pp. 209-215. doi:10.1016/j.athoracsur.2011.03.131
[4] M. R. Bladergroen, J. E. Lowe and R. W. Postlethwait, “Diagnosis and Recommended Management of Esophageal Perforation and Rupture,” The Annals of Thoracic Surgery, Vol. 42, No. 3, 1986, pp. 235-239. doi:10.1016/S0003-4975(10)62725-7
[5] M. G. Sarr, J. H. Pemberton and W. S. Payne, “Management of Instrumental Perforations of the Esophagus,” Journal of Thoracic and Cardiovascular Surgery, Vol. 84, No. 2, 1982, pp. 211-218.
[6] K. Tsalis, K. Blouhos, D. Kapetanos, T. Kontakiotis and C. Lazaridis, “Conservative Management for an Esophageal Perforation in a Patient Presented with Delayed Diagnosis: A Case Report,” Cases Journal, Vol. 2, 2009, p. 164. doi:10.1186/1757-1626-2-164
[7] H. Vidarsdottir, S. Blondal, H. Alfredsson, A. Geirsson and T. Gudbjartsson, “Oesophageal Perforations in Iceland: A Whole Population Study on Incidence, Aetiology and Surgical Outcome,” The Thoracic and Cardiovascular Surgeon, Vol. 58, No. 8, 2010, pp. 476-480. doi:10.1055/s-0030-1250347
[8] V. Bresadola, G. Terrosu, A. Favero, et al., “Treatment of Perforation in the Healthy Esophagus: Analysis of 12 Cases. Langenbeck’s Archives of Surgery, Vol. 393, No. 2, 2008, pp. 135-140. doi:10.1007/s00423-007-0234-x
[9] A. Kanowitz and V. Markovchick, “Oesophageal and Diaphragmatic Trauma,” In: P. Rosen, Ed., Emergency Medicine: Concepts and Clinical Practice, 4th Edition, Mosby, St. Louis, 1998, pp. 546-548.
[10] P. Nandi and G. B. Ong, “Foreign Body in the Oesophagus: Review of 2394 Cases,” British Journal of Surgery, Vol. 65, No. 1, 1978, pp. 5-9. doi:10.1002/bjs.1800650103
[11] M. Dahiya and J. S. Denton, “Esophagoaortic Perforation by Foreign Body (Coin) Causing Sudden Death in a 3- Year-Old Child,” American Journal of Forensic Medicine & Pathology, Vol. 20, No. 2, 1999, pp. 184-188. doi:10.1097/00000433-199906000-00016
[12] D. J. Minnich, P. Yu, A. S. Bryant, D. Jarrar and R. J. Cerfolio, “Management of Thoracic Esophageal Perforations,” European Journal of Cardio-Thoracic Surgery, Vol. 40, No. 4, 2011, pp. 931-937.
[13] J. Schenfine and S. M. Griffin, “Oesophageal Emergencies,” In: S. M. Griffin and S. A. Raimes, Eds., Oesophagogastric Surgery—A Companion to Specialist Surgical Practice, 3rd Edition, Elsevier Saunders, Philadelphia, 2006, pp. 365-393.
[14] E. Teh, J. Edwards, J. Duffy and D. Beggs, “Boerhaave’s Syndrome: A Review of Management and Outcome,” Interactive CardioVasc Thoracic Surgery, Vol. 6, No. 5, 2007, pp. 640-643. doi:10.1510/icvts.2007.151936
[15] J. L. Cameron, R. F. Kieffer, T. R. Hendrix, D. G. Mehigan and R. R. Baker, “Selective Nonoperative Management of Contained Intrathoracic Esophageal Disruptions,” The Annals of Thoracic Surgery, Vol. 27, No. 5, 1979, pp. 404-408. doi:10.1016/S0003-4975(10)63335-8
[16] I. C. Wesdorp, J. F. Bartelsman, K. Huibregtse, F. C. den Hartog Jager and G. N. Tytgat, “Treatment of Instrumental Oesophageal Perforation,” Gut, Vol. 25, No. 4, 1984 pp. 398-404. doi:10.1136/gut.25.4.398
[17] N. R. Barrett, “Report of a Case of Spontaneous Perforation of the Oesophagus Successfully Treated by Operation,” British Journal of Surgery, Vol. 35, No. 138, 1947, pp. 216-218.
[18] J. Jougon, T. Mc Bride, F. Delcambre, A. Minniti and J.- F. Velly, “Primary Esophageal Repair for Boerhaave’s Syndrome Whatever the Free Interval between Perforation and Treatment,” European Journal Cardio-Thoracic Surgery, Vol. 25, No. 4, 2004, pp. 475-479. doi:10.1016/j.ejcts.2003.12.029
[19] R. K. Freeman, J. M. Van Woerkom, A. Vyverberg and A. J. Ascioti, “Esophageal Stent Placement for the Treatment of Spontaneous Esophageal Perforations,” The Annals of Thoracic Surgery, Vol. 88, No. 1, 2009, pp. 194-198. doi:10.1016/j.athoracsur.2009.04.004
[20] J. Saabye, H. O. Nielsen and K. Andersen, “Long-Term Observation Following Perforation and Rupture of the Esophagus,” Scandinavian Cardiovascular Journal, Vol. 22, No. 1, 1988, pp. 79-80. doi:10.3109/14017438809106056
[21] J. A. Salo, K. M. Sepp?l?, P. P. Pitk?ranta and E. O. Kivilaakso, “Spontaneous Rupture and Functional State of the Esophagus,” Surgery, Vol. 112, No. 5, 1992, pp. 897-900.
[22] X. B. D’Journo, C. Doddoli, J. P. Avaro, P. Lienne, M. A. Giovannini, R. Giudicelli, P. A. Fuentes and P. A. Thomas, “Long-Term Observation and Functional State of the Esophagus after Primary Repair of Spontaneous Esophageal Rupture,” The Annals of Thoracic Surgery, Vol. 81, No. 5, 2006, pp. 1858-1862. doi:10.1016/j.athoracsur.2005.12.050

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.