Editing Oesophageal perforation (section)

== Specific situations: ==

=== Malignancy ===

** Perforation through a cancer      makes the cancer incurable
** Stenting is favoured - get      situation under control, then resect later
** Disseminated disease, unfit      for surgery -> palliation
** Problem is that any      perforation means disease dissemination and survival is hopeless (0% at 2      years in one series) - therefore shouldn't be dilating potentially      operable tumours
** Could consider resection if      the perforation is separate to the malignancy

=== Achalasia ===

** Healing is often worsened      because of higher pressures
** Most of the time, perf will      be distal
** Myotomy should be done at      same time - on opposite side of oesophagus to perforation

=== Perforation as a complication     of fundoplication ===

** Laparotomy, dismantle      fundoplication, primary repair, repeat fundoplication

=== Leak after oesophagectomy ===

** Bad
** Evaluate conduit for      viability
*** If it's necrotic, will have       to resect everything

=== Prognosis ===

* Overall mortality 15-30%
* Worse prognosis with     increased time to intervention

[[Category:UGIS]]