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The Etiology, Diagnosis, and Management of Esophageal Perforation

  • Review Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Esophageal perforation is a serious and potentially life-threatening medical emergency. Given multiple etiologies and varying clinical presentations of the perforated esophagus, the diagnosis is commonly delayed, complicating expeditious and optimal intervention.

Methods

We thoroughly reviewed the latest literature on the subject and herein describe the various treatment strategies in varying settings.

Results

Treatment depends on multiple factors including the cause and location of the perforation, the time interval between the inciting event and presentation to the managing clinician, the overall medical stability of the patient, comorbidities including pre-existent esophageal pathology or prior foregut operations, and both the location and extent of extra-esophageal fluid collections. Because of these various considerations, determining the best diagnostic and therapeutic approach requires considerable clinical experience and judgment on the part of the physician. Management principles include (1) adequate fluid resuscitation; (2) expeditious administration of appropriate broad-spectrum antibiotics; (3) repair, occlusion, exclusion, diversion, or exteriorization of the perforation site; (4) drainage of extraluminal fluid collections; (5) relief of distal obstruction; and (6) nutritional support.

Conclusions

For decades, operative intervention has been the mainstay of therapy for esophageal perforation. More recently, endoscopic therapies, including stenting, clipping, suturing, or endoscopic vacuum therapy, have been introduced, expanding the clinician’s therapeutic armamentarium while supplanting surgical approaches in many cases. With further experience and introduction of novel therapies, the management of esophageal perforation undoubtedly will continue to evolve.

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Data Availability

Reprints will not be available from the author.

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Acknowledgements

Jory Barone from the research library for obtaining permission to reprint.

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Author notes

  1. Puja Gaur Khaitan and Amber Famiglietti are first co-authors and contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, D.C., 20010, USA

    Puja Gaur Khaitan & Amber Famiglietti

  2. Division of Thoracic and Esophageal Surgery, Dept. of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, 110 Irving Street, NW (G253), Washington, D.C., 20010, USA

    Puja Gaur Khaitan

  3. Section of Thoracic Surgery, Department of Surgery, Beaumont Health, Detroit, MI, USA

    Thomas J. Watson

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  1. Puja Gaur Khaitan
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Correspondence to Puja Gaur Khaitan.

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Khaitan, P.G., Famiglietti, A. & Watson, T.J. The Etiology, Diagnosis, and Management of Esophageal Perforation. J Gastrointest Surg 26, 2606–2615 (2022). https://doi.org/10.1007/s11605-022-05454-2

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