Esophageal Perforation and Tears

Excerpt

Esophageal perforations and tears present a significant and complex challenge for the therapeutic team, necessitating an interprofessional approach for successful management. These injuries can occur in 3 distinct anatomical compartments—cervical, thoracic, and abdominal—each with a range of often nonspecific symptoms. This variability in presentation can lead to significant delays in diagnosis, complicating the management of the condition. Despite advancements in diagnostic technologies and therapeutic strategies, esophageal perforations and tears remain life-threatening, with mortality rates reaching up to 50%.

The incidence of esophageal perforation in the United States is approximately 3 per 100,000 individuals, with intrathoracic perforations being the most common, accounting for 54% of cases. Cervical esophageal perforations follow at 27%, while intraabdominal perforations comprise 19%. Iatrogenic causes, particularly those related to endoscopic procedures, are the leading contributors to esophageal perforation, responsible for 59% of cases. In contrast, traumatic external injuries rarely result in esophageal perforation; however, when foreign objects are involved, fish bones are the most frequent cause, accounting for 12% of cases.

The concurrence of esophageal perforation and mediastinal abscesses is relatively rare, but when it occurs, it can lead to severe complications such as thoracic abscess, sepsis, and septic shock, with mortality rates as high as 66%. The critical importance of prompt identification and diagnosis cannot be overstated, as studies show that delays in diagnosis significantly increase mortality rates. Treatment strategies for esophageal perforations, particularly those complicated by mediastinal abscesses, often involve surgical intervention or drainage, underscoring the need for a timely and coordinated therapeutic approach.