Editing Oesophageal perforation (section)

== Initial management ==

* Non-operative management     (majority of patients can be managed non-op!)
** Contained perforation
*** Cavity confined to       mediastinum on endoscopy
*** Drains back into oesophagus       on contrast radiography
** No symptoms or signs of      mediastinitis
** Haemodynamically stable with      no evidence of ongoing sepsis, or only low-grade fevers
** No solid food contamination      of mediastinum OR tolerance to pleural contamination (over 72 hours)
** Perforation through an      oesophageal malignancy
** ICU for 2-3 days - if      deteriorates, will need intervention still
** NPO, head of bed elevated
** NGT decompression
** Broad-spectrum Abx, and      consider antifungal cover for distal perfs
** PPI
** Consider TPN/distal enteral      nutrition
** Repeat imaging in 3-4 days,      and if no further free perf, consider upgrading to liquid diet (serial      contrast studies)
* Source control in chest
** Chest tubes can be used to      drain the area in some cases
** Radiologically-guided drains      also useful
** VATS/open thoracic washout      with decortication might be necessary