Thoracic esophageal perforations.
BACKGROUND
Recognition of the importance of early diagnosis and aggressive, definitive surgical intervention has brought about a dramatic decline in mortality related to distal esophageal perforation.


METHODS
We retrospectively analyzed all cases of thoracic esophageal perforation diagnosed at our hospital from September 1, 1979, through April 1, 2001. The study group consisted of 62 patients (43 men) with a mean age of 58.8 years (range, 20-92 yr).


RESULTS
In the group of 39 patients with early diagnosis (< or = 24 h), hospital survival was 87%, which increased to 93% when early diagnosis was combined with aggressive surgical treatment Among the 23 patients with late diagnosis (> 24 h), survival approached 70%. Yet, in patients who were treated aggressively with surgery, survival was almost 90% despite delayed diagnosis.


CONCLUSIONS
We recommend aggressive, definitive surgery for thoracic esophageal perforations, whether diagnosed early or late. A variety of options are discussed with regard to complicated presentations.
Kiernan
Paul D
PD
Section of Thoracic and Cardiovascular Surgery, Department of Medicine, Inova Fairfax Hospital, Inova Health System, Annandale, VA, USA.
Sheridan
Michael J
MJ
Elster
Eric
E
Rhee
John
J
Collazo
Lucas
L
Byrne
William D
WD
Fulcher
Thomas
T
Hettrick
Vivian
V
Vaughan
Betty
B
Graling
Paula
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004939:Esophageal Perforation / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors