This protocol applies to esophageal perforation presentations in which standard primary repair is not feasible: perforations larger than 10 cm, perforations accompanied by extensive extraluminal contamination or diffuse necrosis, and perforations occurring in the setting of a non-dilatable esophageal stricture or end-stage esophageal disease.
Management involves surgical repair or, where esophageal preservation is not possible, more extensive operative intervention — with the specific strategy determined by contamination extent, underlying pathology, and the patient's operative tolerance.
DOI: 10.1007/s11605-022-05454-2
Primary repair is not feasible, however, for perforation in the setting of a malignancy, large perforations (> 10 cm), or in the presence of diffuse necrosis.
Esophageal diversion with or without esophagectomy is typically reserved for large esophageal perforations with extensive extraluminal contamination, especially in the setting of an underlying malignancy, non-dilatable esophageal stricture, or an end-stage esophagus associated with achalasia.
Options for surgical treatment include open debridement and drainage of the contaminated space with a stent or primary repair of the injury versus esophageal diversion with or without esophagectomy.
Primary repair is the preferred surgical approach whenever possible, as the esophagus is preserved, obviating the need for future reconstruction.
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