Management of delayed diagnosed esophageal perforation

ABSTRACT

The esophageal perforation can be fatal unless diagnosed promptly and treated effectively. The high mortality rate related to delayed treatment is due to an inability to effectively close the perforation site to prevent leakage and ongoing sepsis. This study was performed on patients who were referred to three hospitals of Shaheed Beheshti and Tehran Universities of Medical Sciences during two years. All patients admitted in these hospitals with esophageal perforation lasting for more than 24 hours were studied. There were 24 patients [12 males, 12 females] with the mean age of 37.5 yrs. The most frequent symptoms and signs were Chest and abdominal pain in 11 cases [45.83%], empyema in 11 cases [45.83%], fever in 10 cases [41.66%], pleural effusion in 8 cases [33.33%] and emphysema in 3 cases [12.5%]. The most common causes of esophageal perforation were use of devices during esophagoscopy and foreign bodies in 13 cases [54.17%], iatrogenic trauma in 4 cases [16.67%], Boerhaave's syndrome in 4 cases [16.67%], ingestion of burning chemicals in 2 cases [8.33%] and esophageal cancer in 1 case [4.17%].Four [16.66%] of all patients died while others were discharged with no significant complication in long time. This study was performed on patients referred to university hospitals; therefore, the results are different from those of community. Most of the perforations were due to intraoperative negligence or device manipulation. The outcomes of the whole procedures were good concluding that late diagnosed esophageal perforations can be managed surgically with good results but with a longer period of hospitalization