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Spectrum of oesophageal perforations and their influence on management

Lookup NU author(s): Shajahan Wahed, Barry Dent, Professor Michael Griffin


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BackgroundOesophageal perforations are associated with high mortality and morbidity rates. A spectrum of aetiologies and clinical presentations has resulted in a variety of operative and non-operative management strategies. This analysis focused on the impact of these strategies in a single specialist centre.MethodsAll patients with oesophageal perforation managed in a single oesophagogastric unit in the UK between January 2002 and December 2012 were identified. Gastric perforations and anastomotic leaks were excluded. Data were verified using an endoscopy database, electronic and paper records. Aetiology of perforation, management and outcomes were analysed.ResultsThere were 101 adult patients with oesophageal perforation. Complete records were not available for five patients and they were excluded from the analysis. The median age was 695years. Thoracic perforations were present in 84 per cent of patients. There were 51 spontaneous perforations, 41 iatrogenic and four related to foreign bodies. Oesophageal malignancy was present in 11 patients. Forty-four patients were managed surgically, 47 without operation and five patients were considered unfit for active treatment. The in-hospital mortality rate for treated patients was 24 per cent and median length of hospital stay was 315days.ConclusionThe management of oesophageal perforation requires specialist multidisciplinary input. It is best provided in an environment familiar with the range of treatment modalities. Management decisions should be guided primarily by the degree of contamination rather than the aetiology of the defect. The routine use of stents is unproven and controversial.Still a very high mortality condition

Publication metadata

Author(s): Wahed S, Dent B, Jones R, Griffin SM

Publication type: Article

Publication status: Published

Journal: British Journal of Surgery

Year: 2014

Volume: 101

Issue: 1

Pages: E156-E162

Print publication date: 22/11/2013

ISSN (print): 0007-1323

ISSN (electronic): 1365-2168

Publisher: Wiley-Blackwell Publishing


DOI: 10.1002/bjs.9338


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