Esophageal perforation: a therapeutic challenge.
The records of 64 patients with esophageal perforation treated since 1958 were reviewed. There were 19 cervical perforations, 44 thoracic perforations, and one abdominal perforation. Thirty-one perforations (48%) were due to injury from intraluminal causes. Twenty (31%) resulted from extraluminal causes: penetrating wounds, 11; blunt trauma, 3; and paraesophageal operations, 6. Eleven (17%) were spontaneous perforations, and two (3%) were caused by perforation of an esophageal malignancy. Ten (91%) of 11 patients with cervical perforations treated less than 24 hours after injury survived compared with 6 (75%) of 8 patients treated more than 24 hours after injury; hence 16 (84%) of the 19 patients in the cervical group survived. In the thoracic group, 19 patients were treated within 24 hours with 16 survivors (84%) compared with 25 patients treated beyond 24 hours with 12 survivors (48%); hence 28 (64%) of the 44 patients in the thoracic group survived. The patient with an abdominal perforation survived. Thirty patients underwent primary suture closure of the perforation, and 25 (83%) lived. Seventeen patients had drainage, and 10 (59%) lived. Total esophagectomy was performed in 9 patients, 7 (78%) of whom survived. Exclusion-diversion procedures were performed in 5 patients, and 1 (20%) survived.
Attar
S
S
Department of Surgery, University of Maryland Medical School and Hospital, Baltimore 21201.
Hankins
J R
JR
Suter
C M
CM
Coughlin
T R
TR
Sequeira
A
A
McLaughlin
J S
JS
D000328:Adult; D000367:Age Factors; D004935:Esophageal Diseases / Q000150:complications; D004939:Esophageal Perforation / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D004947:Esophagus / Q000293:injuries / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014950:Wounds, Penetrating / Q000150:complications