[Surgical therapy of esophageal perforation. A determination of current status based on 4 personal cases and the literature].
We present four cases of esophageal rupture (three iatrogenic, one Boerhaave syndrome) to demonstrate the difficulty in diagnosis and therapy. The current literature is discussed and conclusions are drawn as regards the modus operandi. All our patients were operated on. The site of esophageal rupture was always closed with a primary suture and substantial irrigation and drainage were performed. In two cases the suture line was in addition covered with fibrin glue or by an omentum flap, respectively. All patients survived and recovered was unremarkable. Our own results and a subsequent analysis of literature allow the following conclusions. At an early stage of esophageal rupture surgical intervention is indicated. The method of choice is primary closure of the rupture site by suture, possibly combined with a muscle or omentum flap. In cases of delayed diagnosis with advanced mediastinitis, suture of the rupture site should also be striven for. Additional coverage is advisable in these cases. Resection procedures with or without reconstruction should be done only in exceptional cases before of the high surgical risk.
Mai
C
C
Klinik und Poliklinik für Viszeral-, Thorax- und Gefässchirurgie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden.
Nagel
M
M
Saeger
H D
HD
D000368:Aged; D004935:Esophageal Diseases / Q000209:etiology / Q000601:surgery*; D004939:Esophageal Perforation / Q000209:etiology / Q000601:surgery*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012422:Rupture, Spontaneous / Q000209:etiology / Q000601:surgery; D013524:Surgical Flaps; D013536:Suture Techniques
D015718:Fibrin Tissue Adhesive