[Clinical analysis of prognosis in spontaneous esophageal rupture].
OBJECTIVE
Spontaneous esophageal rupture is a life-threatening injury because of delay in diagnosis and rapid progression to septic condition. But acceptable standard treatment strategy has not been established yet. This may be due to its low incidence and lack of published literature. In this study, we evaluated the proper treatment strategy as to decide when and how to manage spontaneous esophageal rupture by analyzing our experiences.


METHODS
Eleven patients who were diagnosed as spontaneous esophageal perforation in Dongsan Medical Center from 1993 to 2003 were analyzed. Patients WERE divided into survival and death group. Clinical manifestations, rupture site and size, treatment methods and complications were compared.


RESULTS
All patients were male and alcoholics. Six patients had survived and five patients died. Age, sites and sizes of ruptures, operation methods were not different in both groups. Before operation, septic condition was present in all patients of death group and more common than survival group (p=0.015). Survival group showed shorter time interval from rupture to initial treatment (p=0.021) and to operation (p=0.019).


CONCLUSIONS
Early diagnosis and initial aggressive treatments such as nothing per oral, pleural and mediastinal drainage are important factor for better prognosis. If possible, early operation such as primary repair must be done. Although any difference according to types of operation method was not found in this study, further study with larger groups seems to be necessary.
Keum
Dong Yoon
DY
Department of Thoracic Surgery, Keimyung University College of Medicine, Daegu, Korea.
Park
Chang Kwon
CK
Park
Kyung Sik
KS
D000328:Adult; D000437:Alcoholism / Q000150:complications; D004935:Esophageal Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012422:Rupture, Spontaneous