Abstract
Introduction
Esophageal and gastroduodenal perforations are relatively uncommon; however, they both can be potentially life-threatening. Esophageal perforations most commonly occur due to iatrogenic injury, forceful retching (Boerhaave’s syndrome), malignancy, foreign body ingestion, or caustic injury. Gastroduodenal perforations are most commonly due to peptic ulcer disease or malignancy. Pain and signs of sepsis are the most common presenting symptoms and signs.
Methods
Determining the extent of critical illness and addressing hemodynamics and sepsis are the first priorities. Identifying the location and size of the perforation as well as extent of contamination is the next priorities. Although surgical intervention has been the mainstay of treatment, newer approaches have led to a heterogeneity of approaches.
Conclusion
For esophageal perforation, observation, endoscopic, radiological, and surgical approaches may be appropriate. For gastroduodenal perforation, surgical approach is still the most appropriate, although a concomitant acid-reducing operation is usually not necessary. Despite these advances, mortality for both perforations can still be high. Sound judgment is necessary for optimal results.
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References
Eroglu, A., et al., Current management of esophageal perforation: 20 years experience. Dis Esophagus, 2009. 22(4): p. 374–80.
Soreide, K., K. Thorsen, and J.A. Soreide, Strategies to improve the outcome of emergency surgery for perforated peptic ulcer. Br J Surg, 2014. 101(1): p. e51-64.
Leeman, M.F., C. Skouras, and S. Paterson-Brown, The management of perforated gastric ulcers. Int J Surg, 2013. 11(4): p. 322–4.
Lindenmann, J., et al., Management of esophageal perforation in 120 consecutive patients: clinical impact of a structured treatment algorithm. J Gastrointest Surg, 2013. 17(6): p. 1036–43.
Nirula, R., Esophageal perforation. Surg Clin North Am, 2014. 94(1): p. 35–41.
Jougon, J., et al., Primary esophageal repair for Boerhaave’s syndrome whatever the free interval between perforation and treatment. Eur J Cardiothorac Surg, 2004. 25(4): p. 475–9.
Sung, S.W., et al., Surgery in thoracic esophageal perforation: primary repair is feasible. Dis Esophagus, 2002. 15(3): p. 204–9.
Bardaxoglou, E., et al., New approach to surgical management of early esophageal thoracic perforation: primary suture repair reinforced with absorbable mesh and fibrin glue. World J Surg, 1997. 21(6): p. 618–21.
Wang, N., et al., Delayed primary repair of intrathoracic esophageal perforation: is it safe? J Thorac Cardiovasc Surg, 1996. 111(1): p. 114–21; discussion 121–2.
Wahed, S., et al., Spectrum of oesophageal perforations and their influence on management. Br J Surg, 2014. 101(1): p. e156-62.
Dasari, B.V., et al., The role of esophageal stents in the management of esophageal anastomotic leaks and benign esophageal perforations. Ann Surg, 2014. 259(5): p. 852–60.
Parodi, A., et al., Endoscopic management of GI perforations with a new over-the-scope clip device (with videos). Gastrointest Endosc, 2010. 72(4): p. 881–6.
Schorsch, T., C. Muller, and G. Loske, Endoscopic vacuum therapy of anastomotic leakage and iatrogenic perforation in the esophagus. Surg Endosc, 2013. 27(6): p. 2040–5.
Byrge, N., et al., Laparoscopic versus open repair of perforated gastroduodenal ulcer: a National Surgical Quality Improvement Program analysis. Am J Surg, 2013. 206(6): p. 957–62; discussion 962–3.
Jayanthi, N.V., Laparoscopic repair of perforated peptic ulcer-technical tip. Surg Laparosc Endosc Percutan Tech, 2013. 23(4): p. e145-6.
Biancari, F., et al., Treatment of esophageal perforation in octogenarians: a multicenter study. Dis Esophagus, 2013.
Kuppusamy, M.K., et al., Evolving management strategies in esophageal perforation: surgeons using nonoperative techniques to improve outcomes. J Am Coll Surg, 2011. 213(1): p. 164–71; discussion 171–2.
Moller, M.H., et al., Quality-of-care initiative in patients treated surgically for perforated peptic ulcer. Br J Surg, 2013. 100(4): p. 543–52.
Montalvo-Jave, E.E., O. Corres-Sillas, and C. Athie-Gutierrez, Factors associated with postoperative complications and mortality in perforated peptic ulcer. Cir Cir, 2011. 79(2): p. 141–8.
Maghsoudi, H. and A. Ghaffari, Generalized peritonitis requiring re-operation after leakage of omental patch repair of perforated peptic ulcer. Saudi J Gastroenterol, 2011. 17(2): p. 124–8.
Lynn, J.J., Y.M. Weng, and C.S. Weng, Perforated peptic ulcer associated with abdominal compartment syndrome. Am J Emerg Med, 2008. 26(9): p. 1071 e3-5.
Gupta, V., et al., Study on the use of T-tube for patients with persistent duodenal fistula: is it useful? World J Surg, 2013. 37(11): p. 2542–5.
Ozmen, M.M., et al., Factors influencing mortality in spontaneous gastric tumour perforations. J Int Med Res, 2002. 30(2): p. 180–4.
Jwo, S.C., et al., Clinicopathological features, surgical management, and disease outcome of perforated gastric cancer. J Surg Oncol, 2005. 91(4): p. 219–25.
Gertsch, P., et al., Free perforation of gastric carcinoma. Results of surgical treatment. Arch Surg, 1995. 130(2): p. 177–81.
So, J.B., et al., Risk factors related to operative mortality and morbidity in patients undergoing emergency gastrectomy. Br J Surg, 2000. 87(12): p. 1702–7.
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Dimou, F., Velanovich, V. Perforations of the Esophagus and Stomach: What Should I Do?. J Gastrointest Surg 19, 400–406 (2015). https://doi.org/10.1007/s11605-014-2702-2
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DOI: https://doi.org/10.1007/s11605-014-2702-2