Management of esophageal perforation

Despite recent advances in thoracic surgery, the management of esophageal p erforation remains problematical and controversial. Thirty-one patients wer e treated for an esophageal perforation between 1986 and 1998. The esophage al perforation was iatrogenic in 25 cases, spontaneous in 2, traumatic in 2 , and caused by a tumor and tuberculous lymphadenitis in 2 patients. There were 10 cervical, 19 thoracic, and 2 abdominal perforations. The interval f rom perforation to operation was less than 24h in 12 patients and more than 24h in 19 patients. The surgical procedures in eluded a primary repair in 12 patients, a resection in 8, and conservative treatment with minor surgic al approaches in 11. The mortality rate was 20% (4/20 patients) in the surg ical treatment group and 45.5% (5/11 patients) in the conservative treatmen t with minor surgery group. The overall mortality was 29% (9/31 patients). The prognosis is thus concluded to depend on the cause and location of the perforation, the presence of underlying esophageal diseases, and the surgic al procedure chosen.