Advertisement

Esophageal Perforation

  • Shaun M. KunisakiEmail author
  • Steven W. Bruch
  • Arnold G. Coran

Abstract

Of all the perforations of the alimentary tract, perforations of the esophagus are considered the most dire and life-threatening. Historically, esophageal perforations in children were treated with highly invasive procedures in similar fashion to those carried out in adults. However, we have learned that esophageal perforations in children are: (i) more often iatrogenic, (ii) more likely to occur within the cervical esophagus, and (iii) not generally associated with an underlying malignant disease process. These important distinctions have allowed for successful non-surgical treatment strategies in the pediatric population. Although there remains a clear role for surgical therapy in selected children with esophageal perforations, the management paradigm has clearly shifted towards less invasive treatment modalities as the first line of therapy in children who are otherwise clinically stable.

Keywords

Esophageal Atresia Esophageal Perforation Thoracic Esophagus Cervical Esophagus Esophageal Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Gander JW, Berdon WE, Cowles RA (2009) Iatrogenic esophageal perforation in children. Pediatr Surg Int 25:395–401PubMedCrossRefGoogle Scholar
  2. 2.
    Engum SA, Grosfeld JL, West KW et al (1996) Improved survival in children with esophageal perforation. Arch Surg 131:604–610Google Scholar
  3. 3.
    Martinez L, Rivas S, Hernandez F et al (2003) Aggressive conservative treatment of esophageal perforations in children. J Pediatr Surg 38:685–689Google Scholar
  4. 4.
    Kim IO, Yeon KM, Kim WS et al (1993) Perforation complicating balloon dilation of esophageal strictures in infants and children. Radiology 189:741–744Google Scholar
  5. 5.
    Gupta NM, Kaman L (2004) Personal management of 57 consecutive patients with esophageal perforation. Am J Surg 187:58–63PubMedCrossRefGoogle Scholar
  6. 6.
    Warden HD, Mucha SJ (1961) Esophageal perforation due to trauma in the newborn. A case report. Arch Surg 83:813–815PubMedCrossRefGoogle Scholar
  7. 7.
    Krasna IH, Rosenfeld D, Benjamin BG et al (1987) Esophageal perforation in the neonate: an emerging problem in the newborn nursery. J Pediatr Surg 22:784–790Google Scholar
  8. 8.
    Mollitt DL, Schullinger JN, Santulli TV (1981) Selective management of iatrogenic esophageal perforation in the newborn. J Pediatr Surg 16:989–993PubMedCrossRefGoogle Scholar
  9. 9.
    Aaronson A, Cywes S, Louw JH (1975) Spontaneous esophageal rupture in the newborn. J Pediatr Surg 10:459–466PubMedCrossRefGoogle Scholar
  10. 10.
    Ajalat GM, Mulder DG (1984) Esophageal perforations. The need for an individualized approach. Arch Surg 119:1318–1320PubMedCrossRefGoogle Scholar
  11. 11.
    Han SY, McElvein RB, Aldrete JS et al (1985) Perforation of the esophagus: correlation of site and cause with plain film findings. Am J Roentgenol 145:537–540Google Scholar
  12. 12.
    Chapdelaine J, Beaunoyer M, Daigneault P et al (2004) Spontaneous pneumomediastinum: are we overinvestigating? J Pediatr Surg 39:681–684Google Scholar
  13. 13.
    Swanson JO, Levine MS, Redfern RO et al (2003) Usefulness of high-density barium for detection of leaks after esophagogastrectomy, total gastrectomy, and total laryngectomy. Am J Roentgenol 181:415–420Google Scholar
  14. 14.
    Lynch FP, Coran AG, Cohen SR et al (1974) Traumatic esophageal pseudodiverticula in the newborn. J Pediatr Surg 9:675–681Google Scholar
  15. 15.
    Panieri E, Millar AJ, Rode H et al (1996) Iatrogenic esophageal perforation in children: patterns of injury, presentation, management, and outcome. J Pediatr Surg 31:890–895Google Scholar
  16. 16.
    Strauss C, Mal F, Perniceni T et al (2010) Computed tomography versus water-soluble contrast swallow in the detection of intrathoracic anastomotic leak complicating esophagogastrectomy (Ivor Lewis): a prospective study in 97 patients. Ann Surg 251:647–651Google Scholar
  17. 17.
    Brewer LA, 3rd, Carter R, Mulder GA et al (1986) Options in the management of perforations of the esophagus. Am J Surg 152:62–69Google Scholar
  18. 18.
    Mathewson C, Jr., Dozier WE, Hamill JP et al (1962) Clinical experiences with perforation of the esophagus. Am J Surg 104:257–266Google Scholar
  19. 19.
    Lyons WS, Seremetis MG, deGuzman VC et al (1978) Ruptures and perforations of the esophagus: the case for conservative supportive management. Ann Thorac Surg 25:346–350Google Scholar
  20. 20.
    Cameron JL, Kieffer RF, Hendrix TR et al (1979) Selective nonoperative management of contained intrathoracic esophageal disruptions. Ann Thorac Surg 27:404–408Google Scholar
  21. 21.
    Shaffer HA, Jr., Valenzuela G, Mittal RK (1982) Esophageal perforation. A reassessment of the criteria for choosing medical or surgical therapy. Arch Intern Med 152:757–761CrossRefGoogle Scholar
  22. 22.
    Broto J, Asensio M, Jorro CS et al (1999) Conservative treatment of caustic esophageal injuries in children: 20 years of experience. Pediatr Surg Int 15:323–325Google Scholar
  23. 23.
    Vogel SB, Rout WR, Martin TD et al (2005) Esophageal perforation in adults: aggressive, conservative treatment lowers morbidity and mortality. Ann Surg 241:1016–1021Google Scholar
  24. 24.
    Garey CL, Laituri CA, Kaye AJ et al (2010) Esophageal perforation in children: a review of one institution’s experience. J Surg Res 164:13–17Google Scholar
  25. 25.
    van der Zee DC, Festen C, Severijnen RS, et al (1988) Management of pediatric esophageal perforation. J Thorac Cardiovasc Surg 95:692–695Google Scholar
  26. 26.
    Wright CD, Mathisen DJ, Wain JC et al (1995) Reinforced primary repair of thoracic esophageal perforation. Ann Thorac Surg 60:245–248Google Scholar
  27. 27.
    Peng L, Quan X, Zongzheng J et al (2006) Videothoracoscopic drainage for esophageal perforation with mediastinitis in children. J Pediatr Surg 41:514–517Google Scholar
  28. 28.
    Port JL, Kent MS, Korst RJ et al (2003) Thoracic esophageal perforations: a decade of experience. Ann Thorac Surg 75:1071–1074Google Scholar
  29. 29.
    Eroglu A, Turkyilmaz A, Aydin Y et al (2009) Current management of esophageal perforation: 20 years experience. Dis Esophagus 22:374–380Google Scholar
  30. 30.
    Qadeer MA, Dumot JA, Vargo JJ et al (2007) Endoscopic clips for closing esophageal perforations: case report and pooled analysis. Gastrointest Endosc 66:605–611Google Scholar
  31. 31.
    Freeman RK, van Woerkom JM, Ascioti AJ (2007) Esophageal stent placement for the treatment of iatrogenic intrathoracic esophageal perforation. Ann Thorac Surg 83:2003–2007PubMedCrossRefGoogle Scholar
  32. 32.
    Urschel HC, Jr., Razzuk MA, Wood RE et al (1974) Improved management of esophageal perforation: exclusion and diversion in continuity. Ann Surg 179:587–591Google Scholar
  33. 33.
    Hendren WH, Henderson BM (1968) Immediate esophagectomy for instrumental perforation of the thoracic esophagus. Ann Surg 168:997–1003PubMedCrossRefGoogle Scholar
  34. 34.
    Orringer MB, Stirling MC (1990) Esophagectomy for esophageal disruption. Ann Thorac Surg 49:35–42PubMedCrossRefGoogle Scholar
  35. 35.
    Hirschl RB, Yardeni D, Oldham K et al (2002) Gastric transposition for esophageal replacement in children: experience with 41 consecutive cases with special emphasis on esophageal atresia. Ann Surg 236:531–539Google Scholar
  36. 36.
    Kimberley KL, Ganesh R, Anton CK (2011) Laparoscopic repair of esophageal perforation due to Boerhaave syndrome. Surg Laparosc Endosc Percutan Tech 21:e203–e205PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2013

Authors and Affiliations

  • Shaun M. Kunisaki
    • 1
    Email author
  • Steven W. Bruch
  • Arnold G. Coran
  1. 1.CS Mott Children’s HospitalUniversity of MichiganAnn ArborUSA

Personalised recommendations