0
Abstract: Poster Presentations |

SUPERIOR MANAGEMENT OF ESOPHAGEAL PERFORATIONS: AN EMPHASIS ON DIVERSION AND DRAINAGE FREE TO VIEW

Thomas A. Brown, MD*; Geoffrey M. Graeber, MD; Michael F. Szwerc, MD; Gordon F. Murray, MD
Author and Funding Information

West Virginia University, Morgantown, WV


Chest


Chest. 2005;128(4_MeetingAbstracts):308S. doi:10.1378/chest.128.4_MeetingAbstracts.308S
Text Size: A A A
Published online

Abstract

PURPOSE:  Uncontained esophageal perforation is a devastating injury with a mortality rate approaching 20%. Early surgical repair supported by esophageal exclusion, early nutrional support, gastric drainage, and thorough pleural drainage should yield superior results.

METHODS:  The records of all patients treated esophageal perforations at one university medical center from 1988-2003 were collected and analyzed. Optimal treatment consisted of surgical repair, proximal esophageal and gastric decompression, thorough pleural drainage, initiation of nutritional support within 2 days, and IV antibiotics.

RESULTS:  Forty patients were identified (37 adult and 3 pediatric). The age range was 0-87 years (mean 59.1). The male: female ratio was 1:1. Overall mortality rate primarily, had nasogastric suction, pleural and/or mediastinal drainage, and nutritional support. All had successful repairs with 0% mortality.Thirty-four patients had esophageal perforations in the distal two-thirds. Seven received conservative therapy of drainage, IV antibiotics, nutritional support, but no primary repair. Two died of continuing sepsis and five survived. Twenty-six patients were treated early with 11.5% mortality and 7 patients were treated late with 14.3% mortality. Twelve patients received suboptimal therapy with one or more of the major components of treatment being omitted. Four of these patients died (mortality rate 33.3%). Fifteen received optimal treatment with all of the major components with 0% mortality. Number of pleural and mediastinal drains placed was proportional to survival, with 4-6 drains yielding 0% mortality.

CONCLUSION:  Prompt surgical repair supported by proximal esophageal exclusion without defunctionalization, gastric decompression, thorough pleural drainage, nutritional support within 2 days, and IV antibiotics yields excellent results in patients suffering from uncontained perforations of the distal two-thirds esophagus.

CLINICAL IMPLICATIONS:  Early drainage and appropriate nutritional support yield excellent results in complex esophageal perforations.

DISCLOSURE:  Thomas Brown, None.

Wednesday, November 2, 2005

12:30 PM - 2:00 PM


Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543