[Perforation and rupture of the oesophagus: treatment and prognosis].
OBJECTIVE
To analyze treatment and prognosis of perforations and ruptures of the oesophagus.


METHODS
This retrospective study included 40 patients (26 men and 14 women; mean age = 59 +/- 17 years) with a perforation or a rupture of the oesophagus. Seven perforations were cervical: iatrogenic (n = 6) or following ingestion of a foreign body (n = 1). Thirty-three perforations were thoracic: iatrogenic (n = 15), spontaneous rupture (n = 14), following ingestion of foreign body (n = 3) or traumatic (n = 1). All patients with cervical perforations were operated on (suture or drainage). One patient with thoracic perforation died before surgery, 2 underwent non-operative treatment and 30 were operated on. Twenty-eight underwent an oesophageal procedure: suture (n = 13), oesophagectomy (n = 11) or double exclusion (n = 4). Two uderwent surgery without oesophageal procedure (one pleural decortication, and one ablation of a pleural foreign body).


RESULTS
The overall mortality rate was 17% (7/40), 21% (3/14) after spontaneous ruptures and 19% (4/21) after iatrogenic perforations (no death for other aetiologies). The mortality rate was 14% (1/7) for cervical lesions and 18% (6/33) for thoracic ones. It was 8% (1/13) after intrathoracic suture, 18% (2/11) after oesophagectomy and 50% (2/4) after double exclusion.


CONCLUSIONS
Iatrogenic perforation and spontaneous rupture had the same poor prognosis. Non-surgical treatment is rarely indicated. oesophagectomy is a good option in case of non suturable oesophagus or delayed operation.
Cheynel
N
N
Service de chirurgie digestive, thoracique et cancérologique, centre hospitalier universitaire du Bocage, 2, avenue Maréchal-de-Lattre-de-Tassigny, BP 77908, 21079 cedex, Dijon, France.
Arnal
E
E
Peschaud
F
F
Rat
P
P
Bernard
A
A
Favre
J-P
JP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004106:Dilatation; D017548:Echocardiography, Transesophageal; D004939:Esophageal Perforation / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D016629:Esophagectomy; D004945:Esophagoscopy; D004947:Esophagus / Q000293:injuries; D005260:Female; D005547:Foreign Bodies / Q000150:complications; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011379:Prognosis; D012189:Retrospective Studies; D012421:Rupture; D012422:Rupture, Spontaneous; D013536:Suture Techniques; D013908:Thoracotomy; D016896:Treatment Outcome