[Therapy and course of disease in spontaneous esophageal perforations].
BACKGROUND
Esophageal perforations occur spontaneously or as a complication of endoscopic procedures. Especially in spontaneous perforation there is ongoing debate regarding the best treatment options.


METHODS
24 patients that were treated at two surgical centers (University Halle, City-hospital Bielefeld) after spontaneous esophageal perforations between 1996 and 2005 were analysed retrospectively.


RESULTS
All patients but one underwent surgical treatment with in 2 cases additional stent implantation. Average stay in hospital was 53 days. In-hospital-lethality was 25% (overall lethality 37.5%). Concerning the therapeutic outcome there was no link between patients' age, localization or size of the perforation and the time interval between perforation and treatment. In 22 patients diagnosis was made > 12hrs after the event.


CONCLUSIONS
Main problem of the Boerhaave-syndrome is the septic-toxic disease. Prognostic criteria are the patients' health-state and not factors like size of perforation, time of delay or localization of the perforation. Since in case of survival esophageal resection shows good long-term-results, in doubt a radical surgical procedure should be recommended as primary option. Implanting an esophageal stent might become a useful mean of treating patients with spontaneous perforations.
Thermann
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Klinik für Allgemein-, Viszeral- und Gefässchirurgie, Medizinische Fakultät Universität Halle, Universitätsklinikum Halle-Kröllwitz. florian.thermann@medizin.uni-halle.de
Thermann
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M
Dralle
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003131:Combined Modality Therapy; D016724:Empyema, Pleural / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D004935:Esophageal Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008309:Mallory-Weiss Syndrome / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D008480:Mediastinitis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D012772:Shock, Septic / Q000401:mortality; D015607:Stents; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome