IATROGENIC ESOPHAGEAL PERFORATIONS - A CLINICAL REVIEW

Thirty patients with iatrogenically induced perforation of the oesopha gus were managed in our unit between January 1986 and December 1996. T hirteen (43%) of these injuries were referred after upper gastrointest inal endoscopy performed by physicians. Ten (33%) cases were referred by ENT surgeons and general surgeons referred 7 (23%) cases. Of these patients, 15 (50%) had no abnormality of the oesophagus found before p erforation. Only 18 (60%) of patients were referred within 24 h of inj ury. The mean duration of care required in the intensive care unit was 1.5 days +/-2.5 days and the mean inpatient hospital stay 26.5 days /22.1 days. The mortality was 10% (three cases). Oesophageal perforati on remains a serious life-threatening injury. The early diagnosis of t his uncommon condition requires a high index of suspicion as the sympt oms are often non-specific. Identification of the site of perforation is necessary as the management of cervical and thoracic perforations d iffers considerably. Early referral combined with appropriate therapy would appear to result in a better outcome than previously published d ata. It is therefore suggested that patients with this relatively rare condition should be referred as soon as possible to a centre with exp ertise in its management.