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ARTICLE |

Unsuspected Esophageal Perforation FREE

Stephen E. Vernon, MD; Grant P. Carmichael, Jr, MD
[+] Author Affiliations

Reprint requests to Department of Pathology, the Center for the Health Sciences, University of California, Los Angeles, CA 90024 (Dr Vernon).


JAMA. 1978;240(23):2568-2569. doi:10.1001/jama.1978.03290230060030
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Published online

ESOPHAGEAL perforation has been seen more frequently in recent years because of the increased use of instrumentation as well as the increase in the number of surgical procedures performed on the esophagus.1 Despite aggressive therapy, including surgical drainage and antibiotics, mortality remains high. If therapy is delayed, mortality is reportedly as high as 86%.2 The following cases were recently seen at the University of California at Los Angeles (UCLA) and represent unsuspected perforations of an unusual cause with a fatal outcome.

Report of Cases 

Case 1.—  An 81-year-old man was admitted to the UCLA Medical Center with a three-day history of left precordial pain associated with dyspnea. The pain was increased with deep inspiration and by lying on his left side. A "sore lump" in the throat was noted about one week before admission. Chest roentgenograms demonstrated an elevated left hemidiaphragm, with a left pleural effusion and cardiomegaly.

REFERENCES

Loop FD, Groves LK:  Esophageal perforations . Ann Thorac Surg 10:571-587, 1970;.
Rabinovich S, Smith IM, McCabe BF:  Rupture of the esophagus . Arch Otolaryngol 85:410-415, 1967;.
Brick IB:  Perforation of the esophagus: A complication of instrumentation . Geriatrics 28:104-105, 1972;.
Young J, Demetre N:  Management of esophageal perforation . Surgery 65:264-268, 1969;.
Ashby BS, Hunter-Craig ID:  Foreign body perforation of the gut . Br J Surg 54:382-384, 1967;.
Schwartz GF, Polsky HS:  Ingested foreign bodies of the gastrointestinal tract . Am Surg 42:236-238, 1976;.
Eraklis AJ, Griscom NT, McGovern JB:  Bronchogenic cysts of the mediastinum in infancy . N Engl J Med 281:1150-1155, 1969;.
Salyer DC, Sayler WR, Eggliston JC:  Benign developmental cysts of the mediastinum . Arch Pathol Lab Med 101:136-139, 1977;.
Mayer JE, Murray CA, Varco RL:  The treatment of esophageal perforation with delayed recognition and continuing sepsis . Ann Thorac Surg 23:568-573, 1977;.

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Loop FD, Groves LK:  Esophageal perforations . Ann Thorac Surg 10:571-587, 1970;.
Rabinovich S, Smith IM, McCabe BF:  Rupture of the esophagus . Arch Otolaryngol 85:410-415, 1967;.
Brick IB:  Perforation of the esophagus: A complication of instrumentation . Geriatrics 28:104-105, 1972;.
Young J, Demetre N:  Management of esophageal perforation . Surgery 65:264-268, 1969;.
Ashby BS, Hunter-Craig ID:  Foreign body perforation of the gut . Br J Surg 54:382-384, 1967;.
Schwartz GF, Polsky HS:  Ingested foreign bodies of the gastrointestinal tract . Am Surg 42:236-238, 1976;.
Eraklis AJ, Griscom NT, McGovern JB:  Bronchogenic cysts of the mediastinum in infancy . N Engl J Med 281:1150-1155, 1969;.
Salyer DC, Sayler WR, Eggliston JC:  Benign developmental cysts of the mediastinum . Arch Pathol Lab Med 101:136-139, 1977;.
Mayer JE, Murray CA, Varco RL:  The treatment of esophageal perforation with delayed recognition and continuing sepsis . Ann Thorac Surg 23:568-573, 1977;.
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