Table of Contents
ISRN Surgery
Volume 2011 (2011), Article ID 868356, 4 pages
http://dx.doi.org/10.5402/2011/868356
Clinical Study

Aggressive Surgical Treatment in Late-Diagnosed Esophageal Perforation: A Report of 11 Cases

1Department of General and Thoracic Surgery, Emam Hospital, Urmia University of Medical Sciences, Urmia 57/35, Iran
2Department of Genetics, Motahhari Hospital, Urmia University of Medical Sciences, Urmia 57/35, Iran
3Genius and Talented Student Organization, Student Research Committee (SRC), Urmia University of Medical Sciences, Urmia 57/35, Iran

Received 10 March 2011; Accepted 29 April 2011

Academic Editor: D. A. Linos

Copyright © 2011 Rahim Mahmodlou et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Esophageal perforation is a relatively uncommon and lethal disease usually resulting from endoscopic procedures. Delay in the diagnosis and treatment occurs in more than 50% of cases, leading to a mortality rate of 40% to 60%, but this rate decreases is 10%–25% if treatment is carried out within 24 hours of perforation. Case Presentation. To analyze the characteristics, etiology, site of perforation, presentation, time interval till diagnosis, treatment and outcome of patients with esophageal perforation. Over a five-year period, from October 2004 through March 2009, 11 patients with esophageal perforation were referred to the division of thoracic surgery of a tertiary referral hospital. In eight patients, perforations were thoracic with delayed diagnosis for at least 48 hours. Two patients had cervical esophageal perforation, and one patient had early-diagnosed Boerhaave's syndrome. Eight patients are alive after followup for a period ranging from eight months to five years. In the remaining three patients, cancer was the underlying disease and the reason of death. Conclusion. No patient with esophageal perforation should be deprived from surgical repair due to delayed diagnosis. All, except preterminal patients, should undergo exploration after resuscitation, and appropriate treatment should be carried out depending on the findings during operation. Aggressive treatment is necessary in the case of established mediastinitis.