Acín-Gándara D, Limones-Esteban M, Ramos-Lojo B, Delgado-Millán MÁ, López-Herrero J

Language: Spanish
References: 18
Page: 533-537
PDF size: 440.82 Kb.

ABSTRACT

Background: Esophageal perforation is a disease with high mortality. Treatment is controversial and should be individualized. Elapsed time, location and perforation all play a role in determining the treatment option: from conservative treatment to esophagectomy. We undertook this study to report on primary esophagectomy and reconstruction in esophageal perforations with expert surgeons and selected patients. It is worth noting the rare complication of perforated peptic ulcer on Barrett’s esophagus presented in one of our patients.
Clinical cases: We report two patients with esophageal perforation (one spontaneous and another due to pneumatic esophageal dilation) treated by primary esophagectomy and reconstruction. The patient with spontaneous perforation had Barrett’s esophagus with severe dysplasia and perforated peptic ulcer.
Conclusions: Esophageal resection and immediate reconstruction is controversial. It was decided to resect the esophagus in both cases reported here due to the size of the perforation and esophageal disease in the second case. The primary reason for immediate reconstruction in selected cases is permanent resolution. Primary cervical esophagealgastric anastomosis has a lower risk of contamination and leaks than thoracic anastomosis, resulting in mediastinal drainage and parenteral nutrition. Spontaneous esophageal perforation due to perforated Barrett’s ulcer is uncommon. Finally, we must consider the importance of early diagnosis and treatment. It is essential to consider the size of the perforation, location, previous esophageal disease, age and general status of the patient in order to undertake appropriate management. Emergency surgery should be individualized and depends on surgeon’s experience.

REFERENCES

1. Piardi T, Petracca M, Baiocchi GL, Tiberio GA, Marando A, Coniglio A, et al. The Boerhaave syndrome. Personal experience. Ann Ital Chir 2007;78:209-215.

2. Roig J, Gironés J, García M, Codina-Barreras A, Rodríguez JI, Codina- Cazador A. Exclusión esofagofúndica temporal en la mediastinitis grave por perforación esofágica. Cir Esp 2003;73:351-353.

3. Sung SW, Park JJ, Kim YT, Kim JH. Surgery in thoracic esophageal perforation: primary repair is feasible. Dis Esophagus 2002;15:204-209.

4. Sawyers JL, Lane CE, Foster JH, Daniel RA. Esophageal perforation: an increasing challenge. Ann Thorac Surg 1975;19:233-238.

5. White RK, Morris DM. Diagnosis and management of esophageal perforations. Am Surg 1992;58:113-119.

6. Lawrence DR, Ohri SK, Moxon RE, Townsend ER, Fountain SW. Primary esophageal repair for Boerhaave’s syndrome. Ann Thorac Surg 1999;67:818-820.

7. Kiev J, Amendola M, Bouhaidar D, Sandhu BS, Zhao X, Maher J. A management algorithm for esophageal perforation. Am J Surg 2007;194:103-106.

8. Wright C. Primary repair for delayed recognition of esophageal perforation. In: Ferguson MK, ed. Difficult Decision in Thoracic Surgery: An Evidence-Based Approach. New York: Springer; 2008. pp. 298-304.

9. Richardson JD. Management of esophageal perforations: the value of aggressive surgical treatment. Am J Surg 2005;190:161-165.

10. Wu JT, Mattox KL, Wall MJ Jr. Esophageal perforations: new perspectives and treatment paradigms. J Trauma 2007;63:1173-1184.

11. Richardson JD. Management of esophageal perforations: the value of aggressive surgical treatment. Am J Surg 2005;190:161-165.

12. Pla V, Cuesta MA, van den Broek WT. Treatment of thoracic esophageal perforations. Cir Esp 2005;77:327-331.

13. Abbas G, Schuchert MJ, Pettiford BL, Pennathur A, Landreneau J, Landreneau J, et al. Contemporaneous management of esophageal perforation. Surgery 2009; 146:749-55. [Discussion 755-756.]

14. Wang N, Razzouk AJ, Safavi A, Gan K, Van Arsdell GS, Burton PM. Delayed primary repair of intrathoracic esophageal perforation, is it safe? J Thorac Cardiovasc Surg 1996;111:114-122.

15. Martínez L, Rivas S, Hernández F, Ávila LF, Lassaletta L, Murcia J, et al. Aggressive conservative treatment of esophageal perforations in children. J Pediatr Surg 2003;38:685-689

16. Vogel S, Rout R, Martin T, Abbitt P. Esophageal perforation in adults: aggressive, conservative treatment lowers morbidity and mortality. Ann Surg 2005;241:1016-1023.

17. Guillem PG, Porte HL, Saudemont A, Quandalle PA, Wurtz AJ. Perforation of Barrett’s ulcer: a challenge in esophageal surgery. Ann Thorac Surg 2000;69:1707-1710.

18. Limburg AJ, Hesselink EJ, Kleibeuker JH. Barrett’s ulcer: cause of spontaneous oesophageal perforation. Gut 1989;30:404-405.