ROLE OF CONSERVATIVE TREATMENT, SURGICAL- TREATMENT AND INTERVENTIONAL RADIOLOGY FOR THE PERFORATED OR RUPTURED ESOPHAGUS

We have reviewed all the records of 23 patients hospitalized in our in stitution from January 1981 till December 1991 and presenting a confir med diagnosis of esophageal perforation. We have studied the aetiology , the localization, morbidity and mortality and we discuss the therape utic management. 9 patients presented;a cervical perforation, 13 patie nts a thoracic perforation and 1 patient an abdominal perforation. Amo ng the patients with cervical perforation 2 patients had a local revis ion with drainage, 3 patients a primary suture and 4 patients were tre ated conservatively. No complication was found in this group. The pati ents with thoracic perforation have been trated as follow: 3 conservat ively, 8 with thoracotomy, primary suture +/- patch, drainage, 2 patie nts with thoracotomy and drainage alone. All complications happened in this group: 2 gastro-intestinal bleeding, 2 ARDS, 3 mediastinitis, 1 pneumonia. 2 patients in a very poor general condition died, one with a metastatic breast carcinoma, the other after a CVI with a massive ga stro-intestinal bleeding. The cervical perforations have an excellent prognosis and can be treated conservatively if they are asymptomatic a nd do not display a pleural lesion. The thoracic perforations can be t reated surgically if they are diagnosed early before septic complicati ons. If not, they will be better treated conservatively with drainage. The intraabdominal perforations have to be treated as every intraabdo minal perforation. In this case, we perform a primary suture completed with fundoplication.