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Open Access Highly Accessed Review

Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours

Jon Arne Søreide13* and Asgaut Viste23

Author Affiliations

1 Department of Gastroenterologic Surgery, Stavanger University Hospital, N-4068 Stavanger, Norway

2 Department of Gastroenterologic Surgery, Haukeland University Hospital, N-5021 Bergen, Norway

3 Department of Surgical Science, University of Bergen, N-5021 Bergen, Norway

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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2011, 19:66  doi:10.1186/1757-7241-19-66

Published: 30 October 2011

Abstract

Esophageal perforation is a rare and potentially life-threatening condition. Early clinical suspicion and imaging is important for case management to achieve a good outcome. However, recent studies continue to report high morbidity and mortality greater than 20% from esophageal perforation. At least half of the perforations are iatrogenic, mostly related to endoscopic instrumentation used in the upper gastrointestinal tract, while about a third are spontaneous perforations. Surgical treatment remains an important option for many patients, but a non-operative approach, with or without use of an endoscopic stent or placement of internal or external drains, should be considered when the clinical situation allows for a less invasive approach. The rarity of this emergency makes it difficult for a physician to obtain extensive individual clinical experience; it is also challenging to obtain firm scientific evidence that informs patient management and clinical decision-making. Improved attention to non-specific symptoms and signs and early diagnosis based on imaging may translate into better outcomes for this group of patients, many of whom are elderly with significant comorbidity.

Keywords:
Esophagus; perforation; early diagnosis; surgery; non-surgical management; endoscopy