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Ann Surg. 2005 Jun;241(6):1016-21 ;discussion 1021-3.

doi: 10.1097/01.sla.0000164183.91898.74.

Esophageal perforation in adults: aggressive,

conservative treatment lowers morbidity and
mortality
Stephen B Vogel 1 , W Robert Rout, Tomas D Martin, Patricia L Abbitt

Affiliations expand
PMID: 15912051 PMCID: PMC1357179 DOI: 10.1097/01.sla.0000164183.91898.74
Free PMC article

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Abstract
Objective: To evaluate the outcome of aggressive conservative therapy in patients with esophageal
perforation.

Summary background data: The treatment of esophageal perforation remains controversial with a
bias toward early primary repair, resection, and/or proximal diversion. This review evaluates an
alternate approach with a bias toward aggressive drainage of fluid collections and frequent CT and
gastographin UGI examinations to evaluate progress.

Methods: From 1992 to 2004, 47 patients with esophageal perforation (10 proximal, 37 thoracic)
were treated (18 patients early [<24 hours], 29 late). There were 31 male and 16 females (ages 18-
90 years). The etiology was iatrogenic (25), spontaneous (14), trauma (3), dissecting thoracic
aneurysm (3), and 1 each following a Stretta procedure and Blakemore tube placement.

Results: Six of 10 cervical perforations underwent surgery (3 primary repair, 3 abscess drainage).
Nine of 10 perforations healed at discharge. In 37 thoracic perforations, 2 underwent primary repair
(1 iatrogenic, 1 spontaneous) and 4 underwent limited thoracotomy. Thirty-4 patients (4 cervical,
28 thoracic) underwent nonoperative treatment. Thirteen of the 14 patients with spontaneous
perforation (thoracic) underwent initial nonoperative care. Overall mortality was 4.2% (2 of 47
patients). These deaths represent 2 of 37 thoracic perforations (5.4%). There were no deaths in the
34 patients treated nonoperatively. Esophageal healing occurred in 43 of 45 surviving patients
(96%). Subsequent operations included colon interposition in 2, esophagectomy for malignancy in
3, and esophagectomy for benign stricture in 2.

Conclusions: Aggressive treatment of sepsis and control of esophageal leaks leak lowers mortality
and morbidity, allow esophageal healing, and avoid major surgery in most patients.

Figures

FIGURE 1. A, An FIGURE 2. A posterior FIGURE 3. A, A

extensive esophageal placed radiologic radiologically placed
leak… chest… “pigtail”…

FIGURE 5. A contained
FIGURE 4. A standard
mediastinal perforation
chest tube (A)…
heals…

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MeSH terms
Adolescent
Adult
Aged
Aged, 80 and over
Chest Tubes
Contrast Media
Diatrizoate Meglumine
Drainage
Esophageal Perforation / diagnosis
Esophageal Perforation / etiology
Esophageal Perforation / mortality
Esophageal Perforation / surgery*
Female
Humans
Iatrogenic Disease
Length of Stay
Male
Middle Aged
Morbidity
Retrospective Studies
Wound Healing

Substances
Contrast Media
Diatrizoate Meglumine

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