Perforation of Barrett’s ulcer: a challenge in esophageal surgery

Background. Barrett’s ulcer, which develops within Barrett’s esophagus, is frequently responsible for bleeding. Perforation is a rare complication constituting a great challenge for diagnosis and management. Methods. Three personal cases and 31 published reports of perforated Barrett’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 determined 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 esophagectomy and esophageal diversion-exclusion were the most frequent procedures, and overall mortality was 45%. Conclusions. The poor prognosis of perforated Barrett’s ulcer should be improved by earlier diagnosis and adequate emergent operation. Although early esophagectomy constitutes the recommended procedure, esophageal diversion-exclusion, which allows control of both sepsis and bleeding, is also of interest.