High risk and low prevalence diseases: Esophageal perforation

Anthony DeVivo, Alexander Y. Sheng, Alex Koyfman, Brit Long

Research output: Contribution to journalReview articlepeer-review

Abstract

Introduction: Esophageal perforation is a rare but serious condition associated with a high rate of morbidity and mortality. Objective: This article highlights the pearls and pitfalls of esophageal perforation, including diagnosis, initial resuscitation, and management in the emergency department based on current evidence. Discussion: Esophageal perforation occurs with injury to the layers of the esophagus, resulting in mediastinal contamination and sepsis. While aspects of the history and physical examination may prompt consideration of the diagnosis, the lack of classic signs and symptoms cannot be used to rule out esophageal perforation. Chest radiograph often exhibits indirect findings suggestive of esophageal perforation, but these are rarely diagnostic. Advanced imaging is necessary to make the diagnosis, evaluate the severity of the injury, and guide appropriate management. Management focuses on hemodynamic stabilization with intravenous fluids and vasopressors if needed, gastric decompression, broad-spectrum antibiotics, and a thoughtful approach to airway management. Proton pump inhibitors and antifungals may be used as adjunctive therapies. Current available evidence for various treatment options (conservative, endoscopic, and surgical interventions) for esophageal perforation and resulting patient outcomes are limited. A multidisciplinary team approach with input from thoracic surgery, interventional radiology, gastroenterology, and critical care is recommended, with admission to the intensive care setting. Conclusions: An understanding of esophageal perforation can assist emergency physicians in diagnosing and managing this deadly disease.

Original languageEnglish (US)
Pages (from-to)29-36
Number of pages8
JournalAmerican Journal of Emergency Medicine
Volume53
DOIs
StatePublished - Mar 2022

Keywords

  • Boerhaave syndrome
  • Esophageal perforation
  • Rupture

ASJC Scopus subject areas

  • Emergency Medicine

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