Management of Esophageal Perforations in Elderly Patients

Abstract

Background: Limited data are available on the management of esophageal perforations in elderly patients. The aim of this study is to analyze the characteristics and treatments of esophageal perforations in elderly patients. Methods: Data on patients with esophageal perforations and older than 65 years of age were retrospectively reviewed from January 2001 to November 2012. Surgery-related and caustic-induced perforations were excluded in this study. Disease-related parameters, such as sex, bacteriology, locations, time to treatment, treatment types, and outcomes, were analyzed. A new method, cervical esophageal ligation and T-tube diversion following repair of esophageal perforations, was introduced. Results: A total of 61 patients, 24 females and 37 males, were eligible for this study. Heterogeneous presentations were noted following diagnosis of esophageal perforations. Esophagoscopy was the most frequently used method for diagnosis of esophageal perforations. Different sites of perforations would induce heterogeneous complications, among which thoracic perforations were most lethal. In this study, disease-related mortality rate was 13.1% (8 patients). Thoracic and abdominal perforations (p 48 hours (p = 0.002) were two significant factors responsible for mortality of patients esophageal perforations. The suggested new diversion method can be used as a salvage treatment option for complicated perforations. Conclusion: Early diagnosis and prompt treatments are the important determinants to reduce mortalities of elderly patients with esophageal perforations. Cervical esophageal ligation combined with T-tube diversion can be considered as a salvage method for complicated perforations.

Keywords

• elderly patients
• esophageal perforation
• proximal ligation
• T-tube diversion