Improved survival in children with esophageal perforation

Scott A. Engum, Jay L. Grosfeld, Karen W. West, Frederick J. Rescorla, L. R. Tres Scherer, William Vaughan

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Objective: To analyze the cause, location, signs and symptoms, presence of underlying disease, time inter val to diagnosis, treatment, and morbidity and mortality in 24 children (19 boys and 5 girls) with esophageal perforation who were treated from 1975 to 1995. Design: Data were collected retrospectively from hospital and office records. Setting: A tertiary care children's hospital. Results: The average age at diagnosis was 58 months (range, 1 day to 19 years). Fourteen children had underlying esophageal disease (atresia, n=7 and gastroesophageal reflux, n=7). Iatrogenic perforations occurred in 17 children: 8 during dilatation, 5 during an antireflux procedure, 2 during endoscopy, and 2 after passage of a feeding tube. Trauma was the cause of perforation in 6 children. In 2 cases the cause was unknown. Perforation occurred in the thoracic esophagus in 12 cases, abdominal esophagus in 7, cervical esophagus in 5, and involved both the thoracic and abdominal esophagus in 1. Signs and symptoms included dysphagia (15 patients), dyspnea (14), fever (12), cyanosis (8), abdominal pain (6), chest pain (5), and subcutaneous emphysema (3). Management of esophageal perforation included nonoperative management (7 patients), drainage alone (1), primary closure (16), and resection and diversion (1). Two perforations occurred in 1 child. Complications occurred in 11 (44%) of the 25 cases and were more common after delayed diagnosis (73%). The average hospital stay was 20 days. There was I death (4%) attributed to esophageal perforation. Conclusions: Morbidity and mortality are directly related to delays in diagnosis and therapy. Most cases of esophageal perforation in children can be closed primarily and the esophagus salvaged despite delayed presentation. The mortality rate in children with esophageal perforation (4%) is significantly less than that for adults (25%-50%).

Original languageEnglish (US)
Pages (from-to)604-611
Number of pages8
JournalArchives of Surgery
Volume131
Issue number6
DOIs
StatePublished - Jan 1 1996
Externally publishedYes

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Esophageal Perforation
Survival
Esophagus
Signs and Symptoms
Mortality
Location Directories and Signs
Thorax
Esophageal Diseases
Morbidity
Subcutaneous Emphysema
Esophageal Atresia
Cyanosis
Hospital Records
Delayed Diagnosis
Enteral Nutrition
Tertiary Healthcare
Deglutition Disorders
Gastroesophageal Reflux
Chest Pain
Dyspnea

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Engum, S. A., Grosfeld, J. L., West, K. W., Rescorla, F. J., Tres Scherer, L. R., & Vaughan, W. (1996). Improved survival in children with esophageal perforation. Archives of Surgery, 131(6), 604-611. https://doi.org/10.1001/archsurg.1996.01430180030005

Improved survival in children with esophageal perforation. / Engum, Scott A.; Grosfeld, Jay L.; West, Karen W.; Rescorla, Frederick J.; Tres Scherer, L. R.; Vaughan, William.

In: Archives of Surgery, Vol. 131, No. 6, 01.01.1996, p. 604-611.

Research output: Contribution to journalArticle

Engum, SA, Grosfeld, JL, West, KW, Rescorla, FJ, Tres Scherer, LR & Vaughan, W 1996, 'Improved survival in children with esophageal perforation', Archives of Surgery, vol. 131, no. 6, pp. 604-611. https://doi.org/10.1001/archsurg.1996.01430180030005
Engum SA, Grosfeld JL, West KW, Rescorla FJ, Tres Scherer LR, Vaughan W. Improved survival in children with esophageal perforation. Archives of Surgery. 1996 Jan 1;131(6):604-611. https://doi.org/10.1001/archsurg.1996.01430180030005
Engum, Scott A. ; Grosfeld, Jay L. ; West, Karen W. ; Rescorla, Frederick J. ; Tres Scherer, L. R. ; Vaughan, William. / Improved survival in children with esophageal perforation. In: Archives of Surgery. 1996 ; Vol. 131, No. 6. pp. 604-611.
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