DIFFERENTIATED TREATMENT OF INTRA-THORACIC ESOPHAGEAL PERFORATIONS

Consecutive patients [44] with esophageal perforation treated during 1969-1978 were reviewed. Thirty perforations were caused by esophagoscopy using a rigid instrument, often combined with dilation and/or biopsy: 4 were caused by a fiberoptic instrument; and 10 were spontaneous ruptures. A benign stricture was the most commonly associated lesion in the esophagus. Six patients with an iatrogenic perforation were treated conservatively without mortality. These patients were characterized by mild symptoms, early recognition, minor leakage from the esophagus and no communication to the pleural cavity. Fourteen patients were treated with closed thoracic drainage. Overall mortality among these patients was 70%, but for those with a spontaneous rupture it was 100%. Twenty-four patients were treated surgically with a mortality of 20%. Individualized treatment is recommended.