[Non-surgical treatment of perforations of the thoracic esophagus].
OBJECTIVE
Thoracic oesophageal perforations are life-threatening conditions requiring immediate treatment. The type of treatment remains however controversial. The aim of this study was to evaluate the efficacy of the nonoperative management in this disease.


METHODS
Six patients were admitted in our surgical unit for thoracic oesophageal perforations during the study period. One perforation was spontaneous (Boerhaave's syndrome). One had complicated an oesophageal ulcer. Two were secondary to caustic lesions. Two were secondary to instrumental dilations. The diagnostic and therapeutic delay was < or = 1 day in 5 cases. In one case the delay was 4 days but the mediastinitis was well tolerated. The treatment was based on antibiotics, nasoesophageal tube suction, and total parenteral nutrition.


RESULTS
There was no death in this group of patients. The mediastinitis healed in all cases. In the follow-up period two patients did not have nutritional restriction after healing. Three patients complained of oesophageal stenosis which required oesophageal replacement (n = 2) and dilation (n = 1). One neoplastic stenosis required an endoprosthesis.


CONCLUSIONS
Nonoperative treatment is feasible and safe in selected cases of thoracic oesophageal perforations: perforations diagnosed early and confined to the mediastinum, instrumental perforations, and perforations diagnosed late but well tolerated.
Slim
K
K
Service de Chirurgie générale et digestive, Hôtel-Dieu, Clermont-Ferrand.
Elbaz
V
V
Pezet
D
D
Chipponi
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D001471:Barrett Esophagus / Q000150:complications*; D002057:Burns, Chemical / Q000150:complications; D002424:Caustics / Q000009:adverse effects; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D004939:Esophageal Perforation / Q000209:etiology / Q000628:therapy*; D004940:Esophageal Stenosis / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000379:methods*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D002424:Caustics
Traitement non-opératoire des perforations de l'oesophage thoracique.