Esophageal perforation: an 8-year review of a multispecialty clinic's experience

Esophageal perforation is the most serious perforation of the gastrointestinal tract, and despite early diagnosis and treatment, mortality remains high. Twenty-four cases of esophageal perforation seen at a large multispecialty clinic between 1983 and 1991 were retrospectively reviewed. Thirteen patients presented with acute perforation, five with subacute, and six with chronic perforation. Eighteen (75%) of 24 perforations resulted from iatrogenic causes, and the rest were spontaneous. Of the iatrogenic perforations, therapeutic endoscopy and paraesophageal surgical complications were responsible for 55% and 33%, respectively. Chest pain, fever, and dyspnea were common presenting signs and symptoms of acute perforation, whereas dysphagia and supraventricular arrhythmia were more prominent features of chronic perforation. All but seven patients had surgical intervention. An overall mortality rate of 46% was noted, and despite early diagnosis and treatment, this mortality was associated with the severity of underlying disease.