TY - JOUR
T1 - High risk and low prevalence diseases
T2 - Esophageal perforation
AU - DeVivo, Anthony
AU - Sheng, Alexander Y.
AU - Koyfman, Alex
AU - Long, Brit
N1 - Funding Information:
BL, AK, AS, AD conceived the idea for this manuscript and contributed substantially to the writing and editing of the review. This manuscript did not utilize any grants, and it has not been presented in abstract form. This clinical review has not been published, it is not under consideration for publication elsewhere, its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder. This review does not reflect the views or opinions of the U.S. government, Department of Defense, U.S. Army, U.S. Air Force, or SAUSHEC EM Residency Program.
Publisher Copyright:
© 2021
PY - 2022/3
Y1 - 2022/3
N2 - 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.
AB - 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.
KW - Boerhaave syndrome
KW - Esophageal perforation
KW - Rupture
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U2 - 10.1016/j.ajem.2021.12.017
DO - 10.1016/j.ajem.2021.12.017
M3 - Review article
C2 - 34971919
AN - SCOPUS:85121989958
SN - 0735-6757
VL - 53
SP - 29
EP - 36
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
ER -