A - 13 Years of Single-Center Experience in the Management and Outcome of Esophageal Perforation

Alawady, Tamer Salem; Elsharawy, Mamdouh; Mansour, Amr Hassan; Elshahidy, Tamer Mohamed; Abdelsalam, Ashraf Hamed

doi:10.21608/zumj.2022.139208.2568

A - 13 Years of Single-Center Experience in the Management and Outcome of Esophageal Perforation

Document Type : Original Article

Authors

¹ cardiothoracic surgery department, faculty medicine, zagazig university, zagazig, egypt

² Cardiothoracic Surgery, Faculty of Medicine, Zagazig University, Egypt

³ Department of Cardiothoracic surgery, Zagazig University, Egypt

⁴ Faculty of Medicine Zagazig University

⁵ Cardiothoracic surgery department, Faculty of Medicine, Zagazig University

10.21608/zumj.2022.139208.2568

Abstract

Objective: Esophageal perforation (EP) is a fatal status that continues to be challenging the management, with the incidence of mortality and morbidity has been reported to reach 40%. Its diagnosis may be tricky as it usually presents with a wide range of non-specific symptoms. Our study aims to report characteristics, relay our experience with EP management, and evaluate the various strategies used. Methods: This study retrospectively evaluated the management of 53 patients with EP over 13 years. The confirmed diagnosis was established by esophagogram with water-soluble contrast, contrast-enhanced computed tomography, and esophago-gastro-duodenoscopy. Initial management was categorized as conservation, endoscopic stent, or surgery. Re-intervention and different outcomes were recorded and analyzed. Results: Thoracic EP is the most common location (71.7%). The most common cause of EP was iatrogenic (35.8%). About 58.5% of patients were diagnosed ≤ 24 hours. The mean Pittsburg severity score was 7.5. The initial management was conservation (35.8%), endoscopic stent (17%), and surgical intervention (47.2%). ICU and organ support were needed in 35.8% and 20.8%, respectively. The mean hospital stay for all patients was 27.7 days. Morbidity and mortality were recorded at 30.2% and 18.9%, respectively. Conclusion: EP management should be flexible with a tailored strategy for every patient. Etiology, site, severity score, time to management, and patient reserve are significant factors in management and prognosis.
Keywords: Esophageal perforation, drainage, iatrogenic, spontaneous, foreign, conservation

Keywords