ReviewEvolving options in the management of esophageal perforation
Section snippets
Material and methods
A review of the literature by search of the MEDLINE database limited to human studies published in English was performed with the keywords “esophageal perforation,” and “Boerhaave's syndrome,” which were then matched to “surgery,” “nonoperative,” and “primary repair.” Articles cited in the references retrieved by MEDLINE search were reviewed. The etiology, pathogenesis, and clinical, diagnostic, surgical, and nonoperative features of esophageal perforation, as well as the current mortality rate
Results
The overall mortality associated with esophageal perforation in 726 patients from series between 1990 and 2003 was 18% (Table 1). The cause and location of the injury, the presence of underlying esophageal pathology, the delay in diagnosis, and the method of treatment determine the rate of morbidity and mortality 5, 7, 8, 42. A comprehensive review of published evidence from 1990 to the present 6, 7, 8, 11, 12, 14, 15, 16, 17, 42, 55, 88, 89, 90, 91, 92 allows an accurate evaluation of common
Comment
Esophageal perforation is a serious disorder that is difficult to diagnose and manage. The majority of cases are caused by instrumentation, and mortality remains close to 20%. Early diagnosis and treatment are essential and reduce mortality by at least 50%. Optimal therapy includes primary repair of the perforation site and elimination of distal obstruction. Nonoperative therapy is appropriate in certain well-defined situations. An immediate and individualized approach is required with each
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