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Zagazig University Medical Journal
محلي Zagazig University, Faculty of Medicine
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Keywords : |
, , , Years , Single-Center Experience , , Management , Outcome , Esophageal
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Abstract: |
Objective: Esophageal perforation (EP) is a fatal status that continues to be challenging the
management, with the incidence of mortality and morbidity has been reported to reach 40%.
Its diagnosis may be tricky as it usually presents with a wide range of non-specific symptoms.
Our study aims to report characteristics, relay our experience with EP management, and
evaluate the various strategies used. Methods: This study retrospectively evaluated the
management of 53 patients with EP over 13 years. The confirmed diagnosis was established
by esophagogram with water-soluble contrast, contrast-enhanced computed tomography, and
esophagus-gastro-duodenoscopy. Initial management was categorized as conservation,
endoscopic stent, or surgery. Re-intervention and different outcomes were recorded and
analyzed. Results: Thoracic EP is the most common location (71.7%). The most common
cause of EP was iatrogenic (35.8%). About 58.5% of patients were diagnosed ≤ 24 hours. The
mean Pittsburg severity score was 7.5. The initial management was conservation (35.8%), an
endoscopic stent (17%), and surgical intervention (47.2%). ICU and organ support were
needed in 35.8% and 20.8%, respectively. The mean hospital stay for all patients
was 27.7 days. Morbidity and mortality were recorded at 30.2% and 18.9%,
respectively. Conclusion: EP management should be flexible with a tailored
strategy for every patient. Etiology, site, severity score, time to management, and
patient reserve are significant factors in management and prognosis.
Keywords: Esophageal perforation, drainage, iatrogenic, spontaneous, conservation.
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