[Esophageal perforations and ruptures: a plea for conservative treatment].
OBJECTIVE
To identify the determinants and results on conservative management of oesophageal perforations and ruptures.


METHODS
Retrospective clinical review of 34 consecutive patients (mean age: 62 years) treated for cervical (n = 10) or thoracic (n = 24) oesophageal disruption between 1985 and 1996. Causes were: spontaneous rupture (n = 10), instrumental perforation (n = 16), alimentary foreign body (n = 6), and blunt (n = 1) or penetrating trauma (n = 1). The diagnostic delay exceeded 24 hours in 15 cases.


RESULTS
A nonoperative management was achieved in 8 patients with no mortality. A conservative surgical treatment was attempted in 23 patients, primary repair in 21 and open drainage in 2, with a 17.4% mortality. Resection (n = 2) or exclusion (n = 1) was performed in 3 patients with no early mortality, but one of them died as result of the subsequent reconstructive operation to restore oesophageal continuity. Overall morbidity was linked to the spontaneous cause of the perforation. Outcome of patients undergoing primary repair was not influenced by the diagnostic delay nor the surrounding sepsis.


CONCLUSIONS
Conservative management should be advocated for the treatment of oesophageal perforations and ruptures, even in case of delayed diagnostiqiagnosis, regardless of the surrounding sepsis and cause of disruption.
Platel
J P
JP
Service de Chirurgie Thoracique et des Maladies de l'Oesophage, Hôpital Sainte-Marguerite, Marseille.
Thomas
P
P
Giudicelli
R
R
Lecuyer
J
J
Giacoia
A
A
Fuentes
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004322:Drainage; D004935:Esophageal Diseases / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004939:Esophageal Perforation / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004947:Esophagus / Q000293:injuries; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D011183:Postoperative Complications; D012421:Rupture; D016019:Survival Analysis; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents