Clinical analysis of the diagnosis and treatment of esophageal perforation

Background: Despite recent advances in treatment strategies, the management of esophageal perforation is still problematical and controversial. The purpose of the present study was to evaluate and compare the clinical data, treatment methods, and outcomes of patients with esophageal perforation according to the patients’ systemic condition (shock, systemic inflammatory response syndrome (SIRS), or non-SIRS) on arrival to the hospital. Methods: Twelve patients were treated for an esophageal perforation between 2004 and 2013. Based on the patients’ pretreatment status, the patients were divided into three groups (shock, SIRS, and non-SIRS groups), and their clinical findings, treatment methods, and outcomes were compared. Results: The numbers of patients in the shock, SIRS, and non-SIRS groups were three, three, and six, respectively. There was a difference in etiologies among the three groups as follows: two patients with spontaneous rupture were in the shock group, two patients with tumor perforation were in the SIRS group, four patients with foreign body were in the non-SIRS group, and patients with iatrogenic causes were included in all groups. The treatment procedures included conservative therapy in 4 non-SIRS patients, primary surgical repair in 4 patients (2 SIRS, 2 non-SIRS), resection in one SIRS patient, and conservative treatment with minor surgical approaches or stenting in 3 shock patients. The mortality rate was 0 %. Conclusion: Tailoring the treatment strategy to the systemic condition of patients with esophageal perforation is important. In particular, patients with shock should be treated conservatively with minor surgical approaches, including temporary stent insertion.