Treatment of perforation in the healthy esophagus: analysis of 12 cases.
BACKGROUND
Perforation of the esophagus still carries high morbidity and mortality rates, and there is no gold standard for the surgical treatment of choice.


METHODS
We reviewed the records of patients treated for esophageal perforation in the last decade at the General Surgery Unit of the University of Udine. Patients suffering from perforation secondary to surgical procedures or neoplastic disease were ruled out.


RESULTS
Eight males (66.7%) and four females (33.3%) met the inclusion criteria. The cause of perforation was iatrogenic in seven cases (58.3%) and spontaneous in five (41.7%). The perforation was in the cervical esophagus in five cases (41.7%) and at thoracic level in the other seven (58.3%). Two patients (16.7%) with cervical lesions were treated conservatively; two (16.7%) underwent primary closure and the insertion of a drainage tube; one patient with a distal cervical lesion underwent diversion esophagostomy; six patients had resection of the entire thoracic esophagus and terminal cervical esophagostomy; one had segmental resection of the distal thoracic esophagus and lateral diversion esophagostomy. In the five patients whose reconstruction was postponed, esophagogastroplasty surgery was performed with an anastomosis at cervical level in four cases and at thoracic level in one. The global mortality rate was 25%. Late diagnosis-more than 24 h after the perforation event-seems to be the only factor correlated with fatal outcome (p = 0.045).


CONCLUSIONS
The choice of treatment for perforation in a healthy esophagus depends mainly on the site and size of the lesion. Cervical lesions may be amenable to conservative treatment or require primary surgical repair, while thoracic lesions with associated sepsis or major loss of substance demand an aggressive approach, with esophageal resection and delayed reconstruction seeming to be the safest option.
Bresadola
Vittorio
V
Department of Surgery, University Hospital Udine, Udine, Italy. vittorio.bresadola@uniud.it
Terrosu
Giovanni
G
Favero
Alessandro
A
Cattin
Federico
F
Cherchi
Vittorio
V
Adani
Gian Luigi
GL
Marcellino
Maria Grazia
MG
Bresadola
Fabrizio
F
De Anna
Dino
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D004935:Esophageal Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D004939:Esophageal Perforation / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy; D004946:Esophagostomy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D018805:Sepsis / Q000209:etiology / Q000401:mortality / Q000601:surgery; D013270:Stomach / Q000601:surgery