Thoracic Esophageal Perforation

Author: Paul Schipper, MD
Institution: OHSU
Date Reviewed: June 2024
Learning Domain: Cardiothoracic Trauma
Learning Objective: Evaluation of and surgical management of thoracic esophageal perforation
PowerPoint File: Thoracic Esophageal Perforation

 

Discussion Points

  • What are the causes of thoracic esophageal perforation?
  • What determines Morbidity and Mortality?
  • What are optimal resuscitative strategies?
  • How is esophageal perforation diagnosed?
  • What are the operative options?
  • When do you operate?
  • When is Non-operative therapy acceptable?
  • Role of Esophageal stenting?
  • Role of Endovac?

 

Esophageal Perforation/Trauma

Morbidity and Mortality is determined by:

  • Delay in diagnosis and treatment
    • Diagnosis < 24hrs, total mortality 14%
    • Diagnosis > 24hrs, total mortality 27%

 

Causes of Esophageal Perforation

  • Instrumental
    • Endoscopy
    • Dilation
      • Balloon and Bouginage
    • Intubation
    • Sclerotherapy
    • Laser Therapy
  • Non-Instrumental
    • Barogenic Trauma
      • Post-emetic Boerhaave’s syndrome.
    • Penetrating Trauma
    • Operative Trauma
    • Caustic Injury
    • Swallowed foreign bodies.

 

Learning Points

  • Esophageal perforation is often Iatrogenic
  • Cervical perforations can often be treated without thoracotomy
  • Intra-thoracic perforation must be small and contained to consider non-operative treatment
    • Unlikely with Boerhaave’s Syndrome
  • Good history & Physical Exam  essential
  • Early intervention = Best outcomes ?