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 language | English |
|---|---|
| Pages (from-to) | 604-611 |
| Number of pages | 8 |
| Journal | Archives of Surgery |
| Volume | 131 |
| Issue number | 6 |
| State | Published - 1996 |
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ASJC Scopus subject areas
- Surgery
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Improved survival in children with esophageal perforation. / Engum, Scott A.; Grosfeld, Jay L.; West, Karen W.; Rescorla, Frederick; Tres Scherer, L. R.; Vaughan, William Glaze.
In: Archives of Surgery, Vol. 131, No. 6, 1996, p. 604-611.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Improved survival in children with esophageal perforation
AU - Engum, Scott A.
AU - Grosfeld, Jay L.
AU - West, Karen W.
AU - Rescorla, Frederick
AU - Tres Scherer, L. R.
AU - Vaughan, William Glaze
PY - 1996
Y1 - 1996
N2 - 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%).
AB - 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%).
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UR - http://www.scopus.com/inward/citedby.url?scp=0029934410&partnerID=8YFLogxK
M3 - Article
C2 - 8645066
AN - SCOPUS:0029934410
VL - 131
SP - 604
EP - 611
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
IS - 6
ER -