Perforation of Barrett's ulcer: A challenge in esophageal surgery

Background. Barrett's ulcer, which develops within Barrett's esophagus, is frequently responsible far bleeding. Perforation is a rare complication con stituting a great challenge for diagnosis and management. Methods. Three personal cases and 31 published reports of perforated Barret t's ulcer were reviewed retrospectively. The site of perforation, clinical presentation, management, and outcome were assessed. Results. The clinical presentation proved to be heterogeneous and was deter mined by the site of perforation: this was the pleural cavity (20% of cases ), mediastinum (20%), left atrium (16.6%), tracheobronchial tract (13.3%), aorta (13.3%), pericardium (10%), or pulmonary vein (6.6%). Early esophagec tomy and esaphageal diversion-exclusion were the most frequent procedures, and overall mortality was 45%. Conclusions. The poor prognosis of perforated Barrett's ulcer should be imp roved by earlier diagnosis and adequate emergent operation. Although early esophagectomy constitutes the recommended procedure, esophageal diversion-e xclusion, which allows control of both sepsis and bleeding, is also of inte rest. (C) 2000 by The Society of Thoracic Surgeons.