Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours
1 Department of Gastroenterologic Surgery, Stavanger University Hospital, N-4068 Stavanger, Norway
2 Department of Gastroenterologic Surgery, Haukeland University Hospital, N-5021 Bergen, Norway
3 Department of Surgical Science, University of Bergen, N-5021 Bergen, Norway
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2011, 19:66 doi:10.1186/1757-7241-19-66Published: 30 October 2011
Esophageal perforation is a rare and potentially life-threatening condition. Early clinical suspicion and imaging is important for case management to achieve a good outcome. However, recent studies continue to report high morbidity and mortality greater than 20% from esophageal perforation. At least half of the perforations are iatrogenic, mostly related to endoscopic instrumentation used in the upper gastrointestinal tract, while about a third are spontaneous perforations. Surgical treatment remains an important option for many patients, but a non-operative approach, with or without use of an endoscopic stent or placement of internal or external drains, should be considered when the clinical situation allows for a less invasive approach. The rarity of this emergency makes it difficult for a physician to obtain extensive individual clinical experience; it is also challenging to obtain firm scientific evidence that informs patient management and clinical decision-making. Improved attention to non-specific symptoms and signs and early diagnosis based on imaging may translate into better outcomes for this group of patients, many of whom are elderly with significant comorbidity.