Aetiology and therapy of pharyngeal and proximal oesophageal perforations

Objective Evaluation of causes, therapy and influence of comorbidity and postoperative complications in patients with pharyngeal and proximal esophageal perforations (PHP).

Materials and methods Review of medical records of 36 patients with PHP treated at at our hospital between 2010 and 2020. Comorbidities were classified according to the Age-adjusted Charlson Comorbidity Index (ACCI) scoring system and postoperative complications according to the Clavien and Dindo scoring system.

Results 15 (41,7%) patients were male, 21 (58,3%) were female. Median age was 73 years, and PHP were usually diagnosed within one day. The median ACCI score was 4 and the most frequent ACCI score was 5. 17 patients (47.2%) developed complications during the course of treatment. 9 out of 17 patients had grade IV complication according to Clavien and Dindo, which corresponds to the highest classification level. The most frequent location was the hypopharynx (n=29/80%). Transcervical suture was performed in most cases (n=20). 4 patients (11.1%, all female) died during the course of treatment.

Conclusion Numerous interventions such as endoscopies present a risk for PHP. In the literature, mortality after PHP varies between 10% and 25%, if treatment was initiated within 24 hours after perforation. A delay in therapy leads to a significant increase in mortality, other factors such as comorbidity or postoperative complications play only a minor role.

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Artikel online veröffentlicht:
24. Mai 2022