Esophageal perforation management: a single-center experience

Abstract

Background: Esophageal perforation is a serious medical condition where a hole or tear develops in the esophagus, the muscular tube that connects the throat to the stomach. Although rare, the condition is potentially life-threatening, as it can lead to infection and inflammation in surrounding tissues, including the mediastinum, pleura, and peritoneum.

Methods: Between 2014 and 2022, a retrospective study was conducted on cases of esophageal rupture treated at our institution. Eighteen cases were included in the study. Patient data, including age, gender, risk factors, delay in diagnosis, diagnostic method, site of perforation, etiology of perforation, treatment approach, complications, length of hospital stay, and outcomes, were collected. The Pittsburgh Severity Score (PSS) was calculated for each patient.

Results: The mean patient age was 46.33 years, with a male predominance (72.2%). Causes included iatrogenic (22.2%), foreign body (50%), and trauma (27.8%). Perforations primarily occurred in the cervical (38.9%), thoracic (33.3%), and distal esophagus (27.8%). Higher mortality was associated with elevated white blood cell count (WBC), delayed diagnosis, and contrast leakage (p<0.05). Computed tomography (CT) findings and complications significantly influenced intensive care unit (ICU) stay, with abscesses reducing and mediastinitis increasing the duration (p<0.05). Other factors, including age, length of hospitalization, gender, etiology, and treatment type, did not significantly affect Pittsburg Severity Scores (p>0.05).

Conclusion: Esophageal perforation remains a challenging clinical condition associated with significant morbidity and mortality. To optimize patient outcomes, rapid diagnosis, risk stratification using tools such as the PSS, and tailored management strategies are essential.

Figure 1

(a) Thoracic esophageal perforation due to a gunshot wound, revealing contrast leakage. (b) Chicken bone causing cervical esophageal perforation. (c) Distal thoracic esophageal perforation after gastric balloon removal. (d) Distal esophageal perforation during myotomy for achalasia.