부산대학교 도서관

Esophageal perforation is uncommon and traditionally has a high rate of morbidity and mortality. Our aim was to perform a 13-year retrospective review of the cases managed in our district general hospital. Thirty-four cases of esophageal perforation diagnosed between 1995 and 2008 were retrospectively analyzed. There were 20 males and 14 females with a median age of 64 (range 23–86) years. The etiology of the perforations were Boerhaave's syndrome ( n= 19), therapeutic endoscopy ( n= 9), diagnostic endoscopy ( n= 2), gastric lavage injury ( n= 1), foreign body ( n= 1), blunt chest trauma ( n= 1), and spontaneous tumor perforation ( n= 1). Only 11 cases (32%) had evidence of surgical emphysema upon examination. In 50% of cases, another clinical diagnosis was initially suspected. Twenty-four were treated surgically and 10 cases managed non-operatively. Surgical treatment included thoracotomy with primary repair ( n= 9), T-tube drainage ( n= 7), emergency esophagectomy ( n= 1), or intra-operative stent insertion ( n= 1). Four cases had primary repair and fundal wrap via abdominal approach without thoracotomy. Two patients were treated with washout and drainage only. Eight patients died overall (in-hospital mortality 23.5%). Esophageal perforations are often initially misdiagnosed and the majority do not have surgical emphysema. There are a wide variety of methods to manage esophageal perforation. Management tailored to the location and size of perforation, degree of contamination, and underlying cause appears to result in a reasonable prognosis. [ABSTRACT FROM AUTHOR]