Esophageal perforation: life threatening complication of endotracheal intubation

Objective: To raise awareness of this complication of tracheal intubation, to emphasize the gravity due to delayed diagnosis, acid to advocate a surgi cal treatment. Methods: Between April 1980 and January 2000, 97 patients we re treated for esophageal perforation in our department. We reviewed the ca ses of perforation occurring after attempted tracheal intubation. Each case is presented. Discussion is focused on diagnosis and treatment. Results: E sophageal perforation occurred after attempted endotracheal intubation in f ive cases among 58 iatrogenic perforations, There were four women and one m an (mean age 72 years). In all cases, it was for a planned operation. Intub ation was performed by a single lumen tube ill three cases and a double lum en tube in two cases. Presenting symptoms were acute in one case and insidi ous in four cases. Free interval before diagnosis and treatment was long in all but one case, with an average of 179 h (range 5-432). Two patients suf fered from septic shock when they were transferred. All patients were opera ted on. Two patients died. Conclusion: Post intubation esophageal perforati on is one of the most life threatening esophageal perforation. Delayed diag nosis is the first cause of gravity. Prevention of this complication begins with recognition of a potentially difficult intubation. Good outcome follo ws from rapid diagnosis and early surgical treatment. (C) 2001 Elsevier Sci ence B.V. All rights reserved.