Esophageal perforation: diagnosis, management and decision-making - a retrospective tertiary centre study

Objective: Perforation of the esophagus is an extremely rare but life-threatening emergency associated with a high morbidity and mortality. Therefore, time-management is of utmost importance and it is crucial to have an algorithm for diagnostic methods and the subsequent decision-making process. Material and Methods: All patients who were diagnosed with an esophageal perforation between 2010 and 2020 at our university hospital were retrospectively analysed. In addition to patient demographics, the diagnostic method, treatment strategy, defect size and location, etiology and mortality were recorded. Results: A total of 27 patients were identified with an esophageal perforation. All patients were diagnosed through a computed tomography initiating the treatment algorithm 18 patients underwent conservative/endoscopic treatment, while 9 patients received primary surgery for event-related complications. The overall mortality rate was 25.9%, 11.1% within the endoscopic group and 55% within the surgical group. Conclusion: A timely diagnosis in cases of an esophageal perforation is of utmost importance. Therefore, every patient should undergo an emergency computed tomography (CT) with oral and intravenous contrast followed by an upper endoscopy if event-related complications are ruled out in the CT.