title: [Conservative management of esophageal perforation after pneumatic dilatation for achalasia].
abstract: OBJECTIVE
  To assess the results and indications of conservative management of esophageal perforation following pneumatic dilatation for achalasia.
  
  
  METHODS
  Thirteen esophageal perforations complicating 524 dilatations in 412 patients (3%) were diagnosed by esophagogram. Medical treatment consisted of nasogastric succion, antibiotics and pleural drainage, if necessary. Conservative surgical treatment included left thoracophrenotomy, perforation closure, controlateral myotomy and anterior fundoplication. Surgical decision was based upon clinical and radiological parameters. Functional outcome was assessed by the means of the Eckardt's grading score.
  
  
  RESULTS
  Six patients were successfully managed by medical treatment. Seven patients underwent conservative surgery, three of whom after failure of medical treatment. The presence of a pneumomediastinum at initial presentation led to immediate (n=2) or delayed (n=2) surgery in all instances. No patients died. In the surgical group, morbidity consisted of one wound infection, one pleural effusion and one venous thrombosis. One severe chest infection occurred in the medical group. Oral feeding was reintroduced after a median of 10 and 11 days in the surgical and medical groups, respectively. Functional results were satisfactory and similar in both groups.
  
  
  CONCLUSIONS
  Conservative medical or surgical management of oesophageal perforation following pneumatic dilatation is safe, if the diagnosis is done early. Pneumomediastinum at initial presentation seems to predict failure of conservative medical treatment.
authors.affiliation: Service de Chirurgie, Hôpital Cochin, 75014 Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Scatton
authors.forename: Marianne
authors.initials: M
authors.lastname: Gaudric
authors.forename: Pierre-Philippe
authors.initials: PP
authors.lastname: Massault
authors.forename: Stanislas
authors.initials: S
authors.lastname: Chaussade
authors.forename: Didier
authors.initials: D
authors.lastname: Houssin
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dousset
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization / Q000009:adverse effects; D004931:Esophageal Achalasia / Q000628:therapy*; D004939:Esophageal Perforation / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome