LAUSR

Oesophageal perforation is a rare, often life-threatening clinical condition with reported mortality rates of 18 to 25%. Early diagnosis is often challenging with many patients presenting late and in shock. Management is even more challenging with a myriad of options but no standard options or criteria. We aim to review our ten-year experience of managing oesophageal perforation and propose an algorithmic approach for managing this condition. A retrospective review of patients diagnosed with oesophageal perforation from 2011 to 2020 was done. Oesophago-gastric anastomotic perforations and corrosive injuries were excluded. The data relevant for the study including Pittsburgh Severity Score (PSS) was collected from the hospital electronic medical records and strengthened using telephonic conversation. Thirty-six patients (M: F-26:10, mean age: 48 years) were included. In 21 (58%) patients, the perforation was localized to the thoracic oesophagus. The commonest cause of perforation was Iatrogenic (n = 22, 61%), followed by spontaneous (n = 9, 25%). A severe PSS score (≥7) was associated with increased risk of operative intervention (76%) and mortality (18%). Eighteen patients (50%) required operative interventions wherein a primary repair was performed in seven (39%) patients, sepsis drainage in eight (44%) patients, and a diversion in one (6%) patient. Overall, eleven (31%) patients required a re-intervention, and the overall in-hospital mortality was 8.3%. Early diagnosis and decision making using an algorithmic approach are critical in the management of oesophageal perforation. PSS score is a useful tool in assessing the severity of disease. A combined multidisciplinary approach involving therapeutic endoscopy, surgery, and critical care is essential. A minimally invasive surgical approach is a feasible option in selected group of patients.