Patient selection: esophageal perforation (iatrogenic, spontaneous, other)
Diagnosis: CT of chest and abdomen with water-soluble contrast
Most perforations occur in the distal esophagus (90%).
Parameters:
(1) location of perforation
(2) contained vs uncontained
(3) number of hours since event
|
Location
|
Containment
|
Number of Hours
|
Intervention
|
|
esophagus
|
yes
|
NA
|
1
|
|
esophagus
|
no
|
NA
|
2
|
|
abdomen
|
NA
|
< 24 hours
|
3
|
|
abdomen
|
NA
|
>= 24 hours
|
4
|
Intervention 1:
(1) nil per os (NPO)
(2) intravenous antibiotics
(3) chest drainage if needed
Intervention 2:
(1) placement of esophageal stent
(2) drainage if needed (laparoscopic or thoracoscopic)
(3) laparoscopic feeding tube (gastrostomy, jejunostomy)
Intervention 3:
(1) placement of esophageal stent
(2) minimally invasive repair with or without gastric wrap
(3) laparoscopic jejunostomy feeding tube
Intervention 4:
(1) placement of esophageal stent
(2) laparoscopic drainage
(3) laparoscopic jejunostomy feeding tube
One third of patients had prolonged intubation and pneumonia.
