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International Journal of Clinical Pharmacy

, Volume 40, Issue 5, pp 953–962 | Cite as

Esophageal perforation: a research review of the anti-infective treatment

  • Jennifer Gregory
  • Jason HechtEmail author
Review Article
First Online:
  • 109 Downloads

Abstract

Background Esophageal perforation is a complex disease state and often difficult to diagnose due to the variability in patient presentation. The chosen anti-infective treatment and duration of anti-infective therapy that patients with esophageal perforation receive has been inconsistent. Choice of anti-infective treatment and duration of therapy may also be highly variable from institution to institution, and can even vary by provider. To our knowledge, there has not been a publication reviewing esophageal perforation with a specific focus on pharmacologic management. Aim of the review The aim of this study is to summarize pertinent research articles focused on the anti-infective treatment of adult patients diagnosed with esophageal perforation. Method Pubmed electronic database was utilized to search for articles meeting pre-defined criteria. Articles were included in this review if they discussed at least 1 of the following 3 criteria: choice of anti-infective treatment regimen, duration of anti-infective therapy, or identification of organisms growing from cultures associated with the esophageal perforation. Results Seventy-seven articles included information related to our research question. No randomized-controlled trials were identified and only 7 identified articles reported all 3 criteria of interest. Conclusion Review of the literature from 1979 to 2017 reveals the need for high quality evidence related to anti-infective treatment in patients diagnosed with esophageal perforation.

Keywords

Anti-infective agents Antimicrobial stewardship Esophageal perforation Literature review 
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Notes

Acknowledgements

None.

Funding

None.

Conflicts of interest

Jennifer Gregory and Jason Hecht declare that they have no conflict of interest.

References

  1. 1.
    Jones WG, Ginsberg RJ. Esophageal perforation: a continuing challenge. Ann Thorac Surg. 1992;53:534–43.CrossRefGoogle Scholar
  2. 2.
    Brinster CJ, Singhal S, Lee L, Marshall MB, Kaiser LR, et al. Evolving options in the management of esophageal perforation. Ann Thorac Surg. 2004;77:1475–83.CrossRefGoogle Scholar
  3. 3.
    Kwong Lam HC, Sang Woo JK, van Hasselt CA. Esophageal perforation and neck abscess from ingested foreign bodies: treatment and outcomes. Ear Nose Throat J. 2003;82(10):786–94.Google Scholar
  4. 4.
    Di Pilato V, Freschi G, Ringressi MN, Pallecchi L, Rossolini GM, et al. The esophageal microbiota in health and disease. Ann N Y Acad Sci. 2016;1381(1):21–33.CrossRefGoogle Scholar
  5. 5.
    Vidarsdottir H, Blondal S, Alfredsson H, Geirsson A, Gudbjartsson T. Oesophageal perforations in Iceland: a whole population study on incidence, aetiology and surgical outcome. Thorac Cardiovasc Surg. 2010;58:476–80.CrossRefGoogle Scholar
  6. 6.
    Cameron JL, Kieffer RF, Hendrix TR, Mehigan DG, Baker RR. Selective nonoperative management of contained intrathoracic esophageal disruptions. Ann Thorac Surg. 1979;27:404.CrossRefGoogle Scholar
  7. 7.
    Altorjay A, Kiss J, Voros A, Bohak A. Nonoperative management of esophageal perforations. Is it justified? Ann Surg. 1997;225:415–21.CrossRefGoogle Scholar
  8. 8.
    Kang MS, Kim KH, Park JY, Kuh SU, Chin DK, et al. Management of esophageal and pharyngeal perforation as complications of anterior cervical spine surgery. World Neurosurg. 2017;102:275–83.CrossRefGoogle Scholar
  9. 9.
    Gaissert HA, Roper CL, Patterson GA, Grillo HC. Infectious necrotizing esophagitis: outcome after medical and surgical intervention. Ann Thorac Surg. 2003;75(2):342–7.CrossRefGoogle Scholar
  10. 10.
    Anwuzia-Iwegbu C, Al Omran Y, Heaford A. Against all odds. Conservative management of Boerhaave’s syndrome. BMJ Case Rep. 2014.  https://doi.org/10.1136/bcr-2013-200485.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Beason HF, Markowitz JE. Pneumomediastinum diagnosed on ultrasound in the emergency department: a case report. Perm J. 2015;19(3):e122–4.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Cheng HT, Cheng CL, Lin CH, Tang JH, Chu YY, et al. Caustic ingestion in adults: the role of endoscopic classification in predicting outcome. BMC Gastroenterol. 2008;8:31.CrossRefGoogle Scholar
  13. 13.
    Adamek HE, Jakobs R, Dorlars D, Martin WR, Kromer MU, et al. Management of esophageal perforations after therapeutic upper gastrointestinal endoscopy. Scand J Gastroenterol. 1997;32(5):411–4.CrossRefGoogle Scholar
  14. 14.
    Aitcheson E, Yon JR, Popoff AM, Warren W, Basu A, et al. Esophageal perforation in a sword swallower. Am Surg. 2016;82(7):e173–5.PubMedGoogle Scholar
  15. 15.
    Almoosa KF, Wardell N, Javaheri S. Elevated glucose in pleural effusion: an early clue to esophageal perforation. Chest. 2007;131(5):1567–9.CrossRefGoogle Scholar
  16. 16.
    Beumer JD, Devitt PG, Thompson SK. Intramural oesophageal dissection. ANZ J Surg. 2010;80(1–2):91–5.CrossRefGoogle Scholar
  17. 17.
    Bhatia NL, Collins JM, Nguyen CC, Jaroszewski DE, Vikram HR, et al. Esophageal perforation as a complication of esophagogastroduodenoscopy. J Hosp Med. 2008;3(3):256–62.CrossRefGoogle Scholar
  18. 18.
    Bonatti H, Stelzmueller I, Berger N, Lechner M, Grif K, et al. Infections caused by Candida krusei in five transplant and two surgical patients. Surg Infect. 2009;10(3):265–71.CrossRefGoogle Scholar
  19. 19.
    Davies B, Black E, Vaughan R. Thoracoscopic drainage of foreign body removal from a posterior mediastinal abscess. Eur J Cardiothorac Surg. 2004;25(5):897–8.CrossRefGoogle Scholar
  20. 20.
    Huang YC, Cheng CY, Liao CY, Hsueh C, Tyan YS, et al. A rare case of acute phlegmonous esophagogastritis compliated with hypopharyngeal abscess and esophageal perforation. Am J Case Rep. 2017;18:125–30.CrossRefGoogle Scholar
  21. 21.
    Ihama Y, Hokama A, Iraha A, Kalda M, Kinjo F, et al. Esophageal perforation by fish bone ingestion. Gastrointest Endosc. 2011;74(4):921.CrossRefGoogle Scholar
  22. 22.
    Jeon YL, Yang JJ, Kim MJ, Lim G, Cho SY, et al. Combined Bacillus licheniformis and Bacillus subtilis infection in a patient with esophageal perforation. J Med Microbiol. 2012;61:1766–9.CrossRefGoogle Scholar
  23. 23.
    Keane M, Gowripalann T, Brodbeck A, Bothma P. A lesson in clinical findings, diagnosis, reassessment and outcome: Boerhaave’s syndrome. BMJ Case Rep. 2012.  https://doi.org/10.1136/bcr-2012-006485.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Kiernan PD, Hernandez A, Byrne WD, Bloom R, Dicicco B, et al. Descending cervical mediastinitis. Ann Thorac Surg. 1998;65(5):1483–8.CrossRefGoogle Scholar
  25. 25.
    Kinzer S, Pfeiffer J, Becker S, Ridder GJ. Severe deep neck space infections and mediastinitis of odontogenic origin: clinical relevance and implications for diagnosis and treatment. Acta Otolaryngol. 2009;129(1):62–70.CrossRefGoogle Scholar
  26. 26.
    Lee W, Siau K, Singh G. Boerhaave’s syndrome presenting as an upper gastrointestinal bleed. BMJ Case Rep. 2013.  https://doi.org/10.1136/bcr-2013-201267.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Mezuki S, Shono Y, Akahoshi T, Hisanaga K, Saeki H, et al. Esophageal perforation due to blunt chest trauma: difficult diagnosis because of coexisting severe disturbance of consciousness. Am J Emerg Med. 2017;35(11):1790.e3–5.CrossRefGoogle Scholar
  28. 28.
    Muder RR, Stout JE, Ying YC. Isolation of Legionella pneumophila serogroup 5 from empyema following esophageal perforation. Chest. 1992;102(5):1601–3.CrossRefGoogle Scholar
  29. 29.
    Reddin A, Mirvis SE, Diaconis JN. Rupture of the cervical esophagus and trachea associated with cervical spine fractures. J Trauma. 1987;27(5):564–6.CrossRefGoogle Scholar
  30. 30.
    Ohri SK, Liakakos TA, Pathi V, Townsend ER, Fountain SW. Primary repair of iatrogenic thoracic esophageal perforation and Boerhaave’s syndrome. Ann Thorac Surg. 1993;55(3):603–6.CrossRefGoogle Scholar
  31. 31.
    Oray NC, Sivrikaya S, Bayram B, Egeli T, Dicle O. Blunt trauma patient with esophageal perforation. West J Emerg Med. 2014;15(6):659–62.CrossRefGoogle Scholar
  32. 32.
    Morimoto Y, Mukai T. Spontaneous esophageal rupture treated by conservative therapy. Jpn J Thorac Cardiovasc Surg. 2000;48(7):473–5.CrossRefGoogle Scholar
  33. 33.
    Razi E, Davoodabadi A, Razi A. Spontaneous esophageal perforation presenting as a right sided pleural effusion: a case report. Tanaffos. 2013;12(4):53–7.PubMedPubMedCentralGoogle Scholar
  34. 34.
    White S. Another case of chest pain on the acute medical take! BMJ Case Rep. 2012.  https://doi.org/10.1136/bcr-2012-006539.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Zhao GJ, Cheng JY, Zhi SC, Jin X, Lu ZQ. Conservative management of esophageal perforation due to external air-blast injury: a case report and literature review. Therap Adv Gastroenterol. 2015;8(4):234–8.CrossRefGoogle Scholar
  36. 36.
    Sato H, Inoue H, Ikeda H, Grace R, Santi E, Yoshida A, et al. Clinical experience of esophageal perforation occurring with endoscopic submucosal dissection. Dis Esophagus. 2014;27(7):617–22.CrossRefGoogle Scholar
  37. 37.
    Sharma N, Jindal M, Mahon B, Pracy P. Hypopharyngeal perforation during endoscopic ultrasound treated by primary repair. Head Neck. 2011;33(5):756–8.CrossRefGoogle Scholar
  38. 38.
    Singh NP, Rizk JG. Oesophageal perforation following ingestion of the over-the-counter ibuprofen capsules. J Laryngol Otol. 2008;122(8):864–6.CrossRefGoogle Scholar
  39. 39.
    Solomonov A, Best LA, Goralnik L, Rubin AE, Yigla M. Pleural empyema: an unusual presentation of esophageal perforation. Respiration. 1999;66:366–8.CrossRefGoogle Scholar
  40. 40.
    Schneider AL, Hicks KE, Matsuoka AJ. Cervical oesophageal perforatin secondary to food consumption in a well-appearing patient. BMJ Case Rep. 2017.  https://doi.org/10.1136/bcr-2017-222576.CrossRefPubMedGoogle Scholar
  41. 41.
    Zori AG, Kirtane TS, Gupte AR, Chauhan SS, Draganov PV, et al. Utility of clinical suspicion and endoscopic re-examination for detection of esophagogastric perforation after pneumatic dilation for achalasia. Endoscopy. 2016;48(2):128–33.PubMedGoogle Scholar
  42. 42.
    Ardengh JC, Domene CE, Valiati LH, Morrell AC. Conervative management of esophageal perforation following obesity surgery. Sao Paulo Med J. 2006;124(5):340–2.CrossRefGoogle Scholar
  43. 43.
    Tsalis K, Blouhos K, Kapetanos D, Kontakiotis T, Lazaridis C. Conservative management for an esophageal perforation in a patient presented with delayed diagnosis: a case report review of the literature. Cases J. 2009;2:6784.CrossRefGoogle Scholar
  44. 44.
    McCourtney JS, Molloy RG, Anderson JR. Endoscopic esophageal perforation presenting as surgical emphysema of the scrotum. Gastrointest Endosc. 1994;40(1):121–2.CrossRefGoogle Scholar
  45. 45.
    Lee W, Kim Y, Chee H, Lee S, Jung H, et al. A wristwatch in the esophagus associated with esophageal perforation: report of an intriguing case. Thorac Cardiovasc Surg. 2012;60(2):172–4.CrossRefGoogle Scholar
  46. 46.
    Keszler P, Buzna E. Surgical and conservative management of esophageal perforation. Chest. 1981;80(2):158–62.CrossRefGoogle Scholar
  47. 47.
    Inoue T, Abe M. Esophageal perforation associated with fracture of the upper thoracic spine from blunt trauma: a case report. Spinal Cord Ser Cases. 2016;2:15034.CrossRefGoogle Scholar
  48. 48.
    Desai MB, Kamdar MS, Kulkarni AG, Bapat RD, Sathe MJ. Oesophageal injury following blunt thoracic trauma: a case report. J Postgrad Med. 1982;28(3):171–3.PubMedGoogle Scholar
  49. 49.
    Matsuda A, Miyashita M, Sasajima K, Nomura T, Makino H, et al. Boerhaave syndrome treated conservatively following early endoscopic diagnosis: a case report. J Nippon Med Sch. 2006;73(6):341–5.CrossRefGoogle Scholar
  50. 50.
    Lin ZH, Teng YS, Lin M. Acute thyroid abscess secondary to oesophageal perforation. J Int Med Res. 2008;36:860–4.CrossRefGoogle Scholar
  51. 51.
    Keller G, Calleja G, Floccard B, Gruner L, Allaouchiche B. An unrecognized esophageal rupture. Ann Fr Anesth Reanim. 2007;26(6):596–9.CrossRefGoogle Scholar
  52. 52.
    Tomaszek DE, Rosner MJ. Occult esophageal perforation associated with cerical spine fracture. Neurosurgery. 1984;14(4):492–4.PubMedGoogle Scholar
  53. 53.
    Hendy PJ, Wong DS, Florin J. Spontaneous oesophageal perforation: an unreported complication of lymphocytic oesophagitis. Gut. 2013;62(11):1668–9.CrossRefGoogle Scholar
  54. 54.
    Brown RH Jr, Cohen PS. Nonsurgical management of spontaneous esophageal perforation. JAMA. 1978;240(2):140–2.CrossRefGoogle Scholar
  55. 55.
    Chao CY, Raj A, Saad N, Hourigan L, Holtmann G. Esophageal perforation, inflammatory mediastinitis and pseudoaneurysm of the thoracic aorta as potential complications of botulinum toxin injection for achalasia. Dig Endosc. 2015;27(5):618–21.CrossRefGoogle Scholar
  56. 56.
    Cross MR, Greenwald MF, Dahhan A. Esophageal perforation and acute bacterial mediastinitis: other causes of chest pain that can be easily missed. Medicine. 2015;94(32):e1232.CrossRefGoogle Scholar
  57. 57.
    Lee DH, Kim NH, Hwang CJ, Lee CS, Kim YT, et al. Neglected esophageal perforation after upper thoracic verebral fracture. Spine J. 2011;11(12):1146–51.CrossRefGoogle Scholar
  58. 58.
    Mariani AW, Pego-Fernandes PM, Samano MN, de Albuquerque Cavalcanti EF, Cevasco JJ, et al. Indolent form of mediastinitis caused by oesophageal perforation from fish bone ingestion. BMJ Case Rep. 2009.  https://doi.org/10.1136/bcr.11.2008.1250.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Kaman L, Iqbal J, Kundil B, Kochhar R. Management of esophageal perforation in adults. Gastroenterol Res. 2010;3(6):235–44.Google Scholar
  60. 60.
    Bufkin BL, Miller JI Jr, Mansour KA. Esophageal perforation: emphasis on management. Ann Thorac Surg. 1996;61:1447–51.CrossRefGoogle Scholar
  61. 61.
    Ivey TD, Simonowitz DA, Dillard DH, Miller DW Jr. Boerhaave syndrome: successful conservative management in three patients with late presentation. Am J Surg. 1981;141(5):531–3.CrossRefGoogle Scholar
  62. 62.
    Almre I, Asser A, Laisaar T. Pharyngoesophageal diverticulum perforatin after anterior cervical fixation. Interact Cardiovasc Thorac Surg. 2014;18(2):240–1.CrossRefGoogle Scholar
  63. 63.
    Bernard AW, Ben-David K, Pritts T. Delayed presentation of thoracic esophageal perforation after blunt trauma. J Emerg Med. 2008;34(1):49–53.CrossRefGoogle Scholar
  64. 64.
    Graling PR, Hetrick VL, Vaughan B, Kiernan PD. Managing the patient with perforated intrathoracic esophagus. AORN J. 1998;68(1):56–8.CrossRefGoogle Scholar
  65. 65.
    Gupta NM, Gupta V, Gupta R, Sudhakar V. Esophageal perforation caused by a blister-wrapped tablet. Asian Cardiovasc Thorac Ann. 2002;10(1):87–8.CrossRefGoogle Scholar
  66. 66.
    Lawrence DR, Ohri SK, Moxon RE, Townsend ER, Fountain SW. Primary esophageal repair for Boerhaave’s syndrome. Ann Thorac Surg. 1999;67(3):818–20.CrossRefGoogle Scholar
  67. 67.
    Minnich DJ, Yu P, Bryant AS, Jarrar D, Cerfolio RJ. Management of thoracic esophageal perforations. Eur J Cardiothorac Surg. 2011;40(4):931–7.PubMedGoogle Scholar
  68. 68.
    Ruiz D, Vranas K, Robinson DA, Salvatore L, Turner JW, et al. Esophageal perforation after gastric balloon extraction. Obes Surg. 2009;19(2):257–60.CrossRefGoogle Scholar
  69. 69.
    Soulellis CA, Hilzenrat N, Levental M. Intramucosal esophageal dissection leading to esophageal perforation: case report and review of the literature. Gastroenterol Hepatol. 2008;4(5):362–5.Google Scholar
  70. 70.
    Ardon H, Van Calenbergh F, Van Raemdonck D, Nafteux P, Depreitere B, et al. Oesophageal perforation after cervical surgery: management in four patients. Acta Neurochir. 2009;151(4):297–302.CrossRefGoogle Scholar
  71. 71.
    Beer-Furlan A, Brock RS, Mendes LS, Mutarelli EG. Minor blunt cervical spine trauma associated with esophageal perforation and epidural empyema. Acta Neurol Belg. 2016;116(4):691–3.CrossRefGoogle Scholar
  72. 72.
    Lu X, Guo Q, Ni B. Esophagus perforation complicating anterior cervical spine surgery. Eur Spine J. 2012;21(1):172–7.CrossRefGoogle Scholar
  73. 73.
    Lu D, Zhao Y. Minimally invasive drainage of a posterior mediastinal abscess through the retropharyngeal space: a report of 2 cases. Ear Nose Throat J. 2015;94(3):E27–9.PubMedGoogle Scholar
  74. 74.
    Nerot C, Jeanneret B, Lardenois T, Lepouse C. Esophageal perforation after fracture of the cervical spine: case report and review of the literature. J Spinal Disord Tech. 2002;15(6):513–8.CrossRefGoogle Scholar
  75. 75.
    Park IH, Lim HK, Song SW, Lee KH. Perforation of esophagus and subseuent mediastinitis following mussel shell ingestion. J Thorac Dis. 2016;8(8):E693–7.CrossRefGoogle Scholar
  76. 76.
    Lucas J, Smith E, Eskander M, McPhee J, Lapinsky A. Esophageal perforation more than 10 years after anterior cervical spine plating. Clin Neurol Neurosurg. 2013;115(9):1842–4.CrossRefGoogle Scholar
  77. 77.
    Lyman D. Spontaneous esophageal perforation in a patient with mixed connective tissue disease. Open Rheumatol J. 2011;5:138–43.CrossRefGoogle Scholar
  78. 78.
    Ikuma H, Ishibashi K, Yamashita K, Joko R, Makihara S, et al. Delayed esophageal perforation 17 years after anterior cervical fusion surgery with plating. J Orthop Sci. 2017;22(3):566–70.CrossRefGoogle Scholar
  79. 79.
    Chimparlee N, Tumkosit M, Leungtaviboon K, Chattranukulchai P. Pyopneumopericardium and empyema thoracis from perforated oesophageal cancer. BMJ Case Rep. 2013.  https://doi.org/10.1136/bcr-2013-010053.CrossRefPubMedPubMedCentralGoogle Scholar
  80. 80.
    Nabili S, Murdoch JR. A case of Boerhaave’s syndrome associated with raised intraocular pressure. Br J Ophthalmol. 2003;87:646–61.CrossRefGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Beaumont Hospital, DearbornDearbornUSA
  2. 2.St. Joseph Mercy Hospital, Ann ArborYpsilantiUSA

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