Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
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Volume 3, Number 6, December 2010, pages 235-244

Management of Esophageal Perforation in Adults


Figure 1.
Figure 1. Management algorithm of esophageal perforation


Table 1. Etiology of Esophageal Perforations
  - Diagnostic endoscopy
  - Endoscopic biopsy
  - Endoscopic dilatations
  - Variceal Sclerotherapy
  - Endoscopic laser therapy
  - Endoscopic Photodynamic therapy
  - Endoscopic Stent Placement
Nasogastric tube placement
Endotracheal intubations
Transesophageal echocardiography
Foreign bodies-
Bones, dentures, button batteries
    - Blunt
    - Penetrating
    - Sword swallowing
Spontaneous or Boerhaave’s syndrome
Caustic agents
    - Acid and alkali
Severe Reflux and Mallory-Weiss tear
Infective causes
    - Candida
    - Herpes
    - Syphilis
    - Tuberculosis
    - Immunodeficiency status
Non esophageal surgery –
Mediastinal and cervical –Thyroid, Lung, spine and mediastinal tumors
Malignancy of esophagus, Lung and other mediastinal structures


Table 2. Diagnosis of Esophageal Perforations
Clinical examinations
Radiology Plain
  - Neck X-ray lateral view
  - Chest X-ray PA view
  - Abdominal X-ray erect
Radiology Contrast
  - Gastrografin study(water soluble contrast)
  - Thin barium swallow study
  - CT scan of chest and abdomen with oral contrast
  - MRI chest and abdomen
  - Ventilation perfusion (V/Q) scan


Table 3. Treatment Options for Esophageal Perforations
OperativeNon operative
Primary closureConservative management
Primary closure with buttressing of repair withEsophageal stenting
  - Pleural flapFibrin glue applications
  - Pericardial fat padEndoclip application
  - Diaphragmatic pedicle graft
  - Omentum onlay graft
  - Rhomboid muscle
  - Latissimus dorsi muscle
  - Intercostal muscle
T-tube drainage
Drainage only
Esophagectomy with
  - Immediate reconstruction
  - Delayed reconstruction
Exclusion and diversion