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Ann Thorac Surg 2004;77:1475-1483
© 2004 The Society of Thoracic Surgeons

Review

Evolving options in the management of esophageal perforation

Clayton J. Brinster, BAa, Sunil Singhal, MDa, Lawrence Lee, BSa, M. Blair Marshall, MDa, Larry R. Kaiser, MDa, John C. Kucharczuk, MDa*

a Department of Surgery, Division of Cardiothoracic Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA

* Address reprint requests to Dr Kucharczuk, Department of Surgery, Thoracic Surgery Section, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104-4227, USA.
e-mail: john.kucharczuk{at}uphs.upenn.edu

Esophageal perforation remains a devastating event that is difficult to diagnose and manage. The majority of injuries are iatrogenic and the increasing use of endoscopic procedures can be expected to lead to an even higher incidence of esophageal perforation in coming years. Accurate diagnosis and effective treatment depend on early recognition of clinical features and accurate interpretation of diagnostic imaging. Outcome is determined by the cause and location of the injury, the presence of concomitant esophageal disease, and the interval between perforation and initiation of therapy. The overall mortality associated with esophageal perforation can approach 20%, and delay in treatment of more than 24 hours after perforation can result in a doubling of mortality. Surgical primary repair, with or without reinforcement, is the most successful treatment option in the management of esophageal perforation and reduces mortality by 50% to 70% compared with other interventional therapies.




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