SURGICAL-MANAGEMENT OF LATE ESOPHAGEAL-PERFORATION

Over sixteen years we have gained experience in the delayed surgical m anagement of esophageal rupture in nine patients who received treatmen ts more than 24 hours after perforation. The causes of perforation wer e Boerhaave's syndrome or barotrauma in four patients, foreign bodies in two, and other causes in three. Three patients presented in septic shock and four in respiratory failure. Three surgical options were use d for treatment: simple thoracic drainage in two patients, T-tube plac ement in four, and esophagectomy with secondary reconstruction in thre e. Eight patients (89%) survived. T-tube placement was effective in th at it was a one-stage operation which could be used on severe esophage al injuries in patients in poor general condition. Three patients who underwent esophagectomy and secondary alimentary restoration required long hospital stays (119, 201, and 648 days). Although the number of c ases is small, T-tube insertion for the late management of esophageal rupture appears to be a simple and effective method which avoids the p ostoperative complications associated with primary closure or two-stag e operations.