Management of esophageal perforation

The majority of esophageal perforations is caused by endoscopic procedures, while the spontaneous rupture, also known as Boerhaave's syndrome, is rare . Regardless of the cause the esophageal perforation is an urgent surgical problem. The main diagnostic method is a water-soluble contrast study of th e esophagus, probably supplemented by a CT-scan. In case of uncertain diagn osis or localisation eosophagoscopy should be performed. We believe that es ophageal perforation should be operated, the factor "time" seems to be impo rtant for prognosis. In case of early surgical treatment (within 24 hours) a primary suture is sufficient and safe. Only after a delay in diagnosis wi th extended mediastinal spillage and necrosis of the esophageal wall the us e of autogenous tissue to buttress the esophageal repair may be necessary. Esophagectomy should only be performed for perforated carcinomas. We treate d 10 patients in a 4-years-period by primary surgical repair combined with drainage. Nine of them survived, only a 82-years old patient died because o f an unresectable perforated esophageal carcinoma.