Esophageal Perforation - Treatment
Nothing should be given by mouth and antibiotics should be started as soon as esophageal perforation is suspected. Treatment requires repair or covering of the hole in the esophagus to prevent leakage of saliva, and drainage of the fluid around the esophagus. The treatment options depend on the time of diagnosis of perforation, location of the perforation, its underlying cause, the patient’s overall state of health and the severity of infection. The treatment options include: esophageal stenting
There has been an increase in use of esophageal stents for treatment of patients with esophageal perforation. The stent is placed for six to eight weeks and is subsequently removed. This procedure should be done in combination with drainage of fluid around the esophagus.
Surgical treatment includes repair of the hole in the esophagus, coverage of the repair with healthy muscle and drainage of the fluid around the esophagus. In cases of esophageal perforation in the neck, open drainage of the fluid around the esophagus will be enough in the majority of cases.
Esophageal perforation in the chest has a higher risk of complications and will require both repair of the hole and drainage of the fluid around the esophagus. In a selected group of patients, esophageal diversion (the esophagus in the neck is brought out and sewn to the skin to divert saliva out of the esophagus to reduce the risk of infection) or esophagectomy may be required.
1. Brinster CJ , Singhal S, Lee L, Marshall MB, Kaiser LR and Kucharczuk JC. Evolving options in the management of esophageal perforation. The Annals of Thoracic Surgery, 77(4), April 2004, Pages 1475-14832. Freeman RK, Van Woerkom JM, Vyverberg A, Ascioti AJ. Esophageal stent placement for the treatment of spontaneous esophageal perforations. Ann Thorac Surg. 2009 Jul;88(1):194-8.3. Sharma P, Kozarek R, and the Practice Parameters Committee of the American College of Gastroenterology. Role of Esophageal Stents in Benign and Malignant Diseases. Am J Gastroenterol 2010; 105:258–273