Wednesday, April 25, 2018

Esophageal Perforation

emDocs - April 23, 2018 - Authors: DeVivo A and Beck-Esmay J
Edited by: Koyfman A and Long B
"Management and disposition 
The diagnosis of esophageal perforation carries significant mortality, and thus all patients, even if nontoxic appearing upon presentation, should still be considered critically ill. These patients will require early consultation of multiple specialists and should be admitted to an ICU.
Early broad-spectrum IV antibiotics, including anaerobic coverage due to concern for gut flora extravasating into the mediastinum
  • Early IV antifungal therapy should also be considered in esophageal rupture due the commonality of candidal colonization. Patients that are immunocompromised, carry a diagnosis of HIV, or are on a proton pump inhibitor are at particularly increased risk.
  • Appropriate intervention for associated pathologies such as chest tube placement for pneumo or hemothorax.
  • Surgical consultation for primary repair, intervention of pneumothorax, hydrothorax, empyema, or significant pneumomediastinum.
  • Gastroenterology consultation, particularly if perforation was iatrogenic, for possible repair.
  • Medical or surgical intensive care consultation for definitive disposition."