Use of large-diameter metallic stents to seal traumatic nonmalignant perforations of the esophagus

Abstract

Background: Surgery for traumatic, non-malignant perforation of the esophagus in patients presenting more than 24 hours after its occurrence carries a high morbidity and mortality. Covered metallic stents have been used to effectively seal perforations in individual patients with Boerhaave's syndrome.

Methods: Eleven consecutive patients presented with esophageal perforation that was caused by Boerhaave's syndrome (n = 5), resection of an epiphrenic diverticulum (n = 2), rigid esophagoscopy (n = 2), extended gastric resection (n = 1), or pneumatic dilation for achalasia (n = 1). A large diameter Flamingo Wallstent (proximal/distal diameters, 30/20 mm) (7 patients) or a large diameter Ultraflex stent (proximal/distal diameters, 28/23 mm) (4 patients) was placed. Pleural cavities were drained with thoracostomy drains, and antibiotics were administered.

Results: The median time from perforation to stent insertion was 60 hours (range, 24 hours to 28 days). The perforation was totally sealed in 10 of 11 patients. Two patients underwent esophageal resection because of incomplete sealing of the perforation or incomplete drainage of the pleural cavity and mediastinum. The other 9 patients recovered uneventfully and resumed a normal diet within 7 to 18 days. In 7 patients, the stents were retrieved endoscopically after a median of 7 weeks (range, 6 to 14 weeks), whereas two patients refused to have the stent retrieved (in one, the stent migrated into the stomach; the other patient died 6 months after stent placement from an unrelated cause).

Conclusions: Traumatic perforation of the esophagus can be treated successfully with large diameter metallic stents, together with adequate drainage of the thoracic cavity.