Back to 2025 Posters
CHARACTERIZATION OF PATIENTS REFERRED TO A TERTIARY CARE CENTER FOR SUSPECTED SPONTANEOUS ESOPHAGEAL PERFORATION
Andrew Keogan
*1,2, Andrés R. Latorre-Rodríguez
1,3, Artur Rybachok
2, Sagar Patel
2, Sumeet K. Mittal
1,21Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ; 2Creighton University School of Medicine, Phoenix, AZ; 3Universidad del Rosario. Escuela de Medicina y Ciencias de la Salud, Bogotá D.C., Colombia
Introduction: Esophageal perforation is a rare but potentially life-threatening condition, with a low incidence and diverse clinical presentations, making a timely and accurate diagnosis challenging. Due to limited experience, primary centers frequently refer suspected cases to tertiary care centers. This study aimed to assess the diagnostic accuracy of referring physicians and describe the clinical and demographic characteristics of patients referred for suspected spontaneous esophageal perforations.
Methods: We conducted a retrospective, observational, single-center study of patients referred to a tertiary esophageal center for suspected perforation from January 4, 2023 to April 23, 2024. Exclusion criteria included age <18 years and a history of esophagectomy, suspected iatrogenic or traumatic causes, or a confirmed perforation before transfer. Data on demographics, comorbidities, presentation, and initial workup were extracted. Diagnostic accuracy was calculated as the proportion of confirmed cases, and non-parametric tests compared characteristics between groups.
Results: Among 54 patients presenting with suspected spontaneous perforation (31 men [55.6%], median age 34 years [IQR 24–56]), 4 were confirmed to have esophageal perforations, resulting in a referring physician diagnostic accuracy of 7.4% (95% CI: 2.0–17.9%). No significant differences were observed between patients with and without confirmed perforations regarding demographics or medical history. Perforation was confirmed via esophagogastroduodenoscopy (EGD) in 1 patient, esophagram in 1 patient, and non-contrast CT findings and clinical presentation in 2 patients. Of these, 1 patient had a fluid collection around the esophagus, and 3 demonstrated pneumomediastinum, fluid around the esophagus, and pleural effusion. Non-contrast chest imaging (CT or chest X-ray) was performed in 98.2% of patients, with pleural effusion significantly more common in the perforation group (75% vs. 12%, p < 0.05), although rates of pneumomediastinum were similar between groups. Perforations were most commonly ruled out by esophagram (72%) and EGD (26%). Respiratory compromise, defined as a respiratory rate >30 bpm and/or increased oxygen requirement, was more common in perforation cases (75% vs. 8%, p < 0.05). However, no significant differences in reported symptoms or other clinical parameters were identified between patients with and without perforations.
Conclusion: The diagnostic accuracy of spontaneous esophageal perforation by referring physicians is limited. Patient history and clinical parameters at the time of primary consultation do not reliably distinguish true perforations. A composite, predictive diagnostic tool incorporating imaging findings could improve diagnostic accuracy at primary levels, thereby reducing unnecessary resource utilization for patients without a perforation.
Back to 2025 Posters
