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Oesophageal perforations in Iceland : a whole population study on incidence, aetiology and surgical outcome

Vidarsdottir, H LU ; Blondal, S; Alfredsson, H; Geirsson, A and Gudbjartsson, T (2010) In The Thoracic and Cardiovascular Surgeon 58(8). p.80-476
Abstract

BACKGROUND: Oesophageal perforation is a rare but life-threatening condition with a significant morbidity and mortality. In this retrospective, nationwide study, the results of oesophageal perforation are reported for a well defined cohort, with special emphasis on the incidence, aetiology and results of surgical treatment.

MATERIAL AND METHODS: 29 consecutive patients (16 males) were diagnosed with perforation of the oesophagus at Landspitali University Hospital between 1980 and 2007. Patients had a mean age of 61 years (range: 7 months-90 years). Type of surgery, complications and survival were recorded. Average follow-up was 76 months.

RESULTS: Age-standardised incidence of oesophageal perforation was 3.1/1,000,000 per... (More)

BACKGROUND: Oesophageal perforation is a rare but life-threatening condition with a significant morbidity and mortality. In this retrospective, nationwide study, the results of oesophageal perforation are reported for a well defined cohort, with special emphasis on the incidence, aetiology and results of surgical treatment.

MATERIAL AND METHODS: 29 consecutive patients (16 males) were diagnosed with perforation of the oesophagus at Landspitali University Hospital between 1980 and 2007. Patients had a mean age of 61 years (range: 7 months-90 years). Type of surgery, complications and survival were recorded. Average follow-up was 76 months.

RESULTS: Age-standardised incidence of oesophageal perforation was 3.1/1,000,000 per year during the study period. Out of 29 patients diagnosed with oesophageal perforation, the diagnosis was missed in 5 cases (17%) and first made at autopsy. Iatrogenic injury was the most frequent cause (52%), followed by spontaneous perforation (24%) and foreign body ingestion (17%). Thoracic perforations were seen in 73% of patients, and 14 patients had an underlying oesophageal disease. Nineteen patients were treated surgically, in 16 cases with drainage of the mediastinum via thoracotomy and insertion of chest tubes. The median time from perforation to surgery was 6.5 h and median length of hospital stay was 15 days (range: 9-83). All surgically treated patients survived surgery, and the 5-year overall survival rate was 69%.

CONCLUSION: More than half of all oesophageal injuries in Iceland are caused by a iatrogenic injury. Mortality is significant and is related to a missed diagnosis. Patients treated surgically all survived surgery; however, complications were frequent and their hospital stay was long.

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author
publishing date
type
Contribution to journal
publication status
published
keywords
Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Diagnostic Errors, Esophageal Perforation, Female, Hospitals, University, Humans, Iatrogenic Disease, Iceland, Incidence, Infant, Kaplan-Meier Estimate, Length of Stay, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Risk Factors, Survival Rate, Time Factors, Treatment Outcome, Young Adult, Journal Article
in
The Thoracic and Cardiovascular Surgeon
volume
58
issue
8
pages
5 pages
publisher
Georg Thieme Verlag
external identifiers
  • scopus:78649505080
ISSN
0171-6425
DOI
10.1055/s-0030-1250347
language
English
LU publication?
no
id
79fe73a9-7b56-4b55-af8d-145ddcc10b0c
date added to LUP
2016-11-17 13:50:35
date last changed
2018-11-21 21:27:26
@article{79fe73a9-7b56-4b55-af8d-145ddcc10b0c,
  abstract     = {<p>BACKGROUND: Oesophageal perforation is a rare but life-threatening condition with a significant morbidity and mortality. In this retrospective, nationwide study, the results of oesophageal perforation are reported for a well defined cohort, with special emphasis on the incidence, aetiology and results of surgical treatment.</p><p>MATERIAL AND METHODS: 29 consecutive patients (16 males) were diagnosed with perforation of the oesophagus at Landspitali University Hospital between 1980 and 2007. Patients had a mean age of 61 years (range: 7 months-90 years). Type of surgery, complications and survival were recorded. Average follow-up was 76 months.</p><p>RESULTS: Age-standardised incidence of oesophageal perforation was 3.1/1,000,000 per year during the study period. Out of 29 patients diagnosed with oesophageal perforation, the diagnosis was missed in 5 cases (17%) and first made at autopsy. Iatrogenic injury was the most frequent cause (52%), followed by spontaneous perforation (24%) and foreign body ingestion (17%). Thoracic perforations were seen in 73% of patients, and 14 patients had an underlying oesophageal disease. Nineteen patients were treated surgically, in 16 cases with drainage of the mediastinum via thoracotomy and insertion of chest tubes. The median time from perforation to surgery was 6.5 h and median length of hospital stay was 15 days (range: 9-83). All surgically treated patients survived surgery, and the 5-year overall survival rate was 69%.</p><p>CONCLUSION: More than half of all oesophageal injuries in Iceland are caused by a iatrogenic injury. Mortality is significant and is related to a missed diagnosis. Patients treated surgically all survived surgery; however, complications were frequent and their hospital stay was long.</p>},
  author       = {Vidarsdottir, H and Blondal, S and Alfredsson, H and Geirsson, A and Gudbjartsson, T},
  issn         = {0171-6425},
  keyword      = {Adolescent,Adult,Aged,Aged, 80 and over,Child,Child, Preschool,Diagnostic Errors,Esophageal Perforation,Female,Hospitals, University,Humans,Iatrogenic Disease,Iceland,Incidence,Infant,Kaplan-Meier Estimate,Length of Stay,Male,Middle Aged,Postoperative Complications,Retrospective Studies,Risk Factors,Survival Rate,Time Factors,Treatment Outcome,Young Adult,Journal Article},
  language     = {eng},
  number       = {8},
  pages        = {80--476},
  publisher    = {Georg Thieme Verlag},
  series       = {The Thoracic and Cardiovascular Surgeon},
  title        = {Oesophageal perforations in Iceland : a whole population study on incidence, aetiology and surgical outcome},
  url          = {http://dx.doi.org/10.1055/s-0030-1250347},
  volume       = {58},
  year         = {2010},
}