Abstract

AbstractThe most common type of esophageal perforation is secondary to medical instrumentation. Many radiographic findings in routine evaluations of patients, if adequately demonstrated and reported by the radiologist, can help the endoscopist to avoid perforations due to predisposing anatomic characteristics. Radiographic evaluation of a suspected esophageal perforation should begin with plain chest films to evaluate the mediastinum for widening and free air or mediastinal emphysema. Films of the neck and abdomen also may be needed if indicated by clinical symptoms. Fluoroscopic evaluation with a water-soluble opaque medium usually enables the perforation to be seen. Demonstrating the site of the perforation is important in guiding the surgeon in his choice of procedure and operative approach. Occasionally, a perforation will have sealed over and cannot be seen; however, mediastinal air can be demonstrated, indicating development of a mediastinitis. Treatment of choice usually is surgical intervention, with concomitant repair of the underlying abnormality.