Perforations of the Esophagus and Stomach: What Should I Do?

Francesca Dimou, Vic Velanovich

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Introduction: Esophageal and gastroduodenal perforations are relatively uncommon; however, they both can be potentially life-threatening. Esophageal perforations most commonly occur due to iatrogenic injury, forceful retching (Boerhaave’s syndrome), malignancy, foreign body ingestion, or caustic injury. Gastroduodenal perforations are most commonly due to peptic ulcer disease or malignancy. Pain and signs of sepsis are the most common presenting symptoms and signs.Methods: Determining the extent of critical illness and addressing hemodynamics and sepsis are the first priorities. Identifying the location and size of the perforation as well as extent of contamination is the next priorities. Although surgical intervention has been the mainstay of treatment, newer approaches have led to a heterogeneity of approaches.Conclusion: For esophageal perforation, observation, endoscopic, radiological, and surgical approaches may be appropriate. For gastroduodenal perforation, surgical approach is still the most appropriate, although a concomitant acid-reducing operation is usually not necessary. Despite these advances, mortality for both perforations can still be high. Sound judgment is necessary for optimal results.

Original languageEnglish
Pages (from-to)400-406
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume19
Issue number2
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Keywords

  • Duodenal perforation
  • Esophageal perforation
  • Gastric perforation

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