The role of oesophageal diversion and exclusion in the management of oesophageal perforations.
OBJECTIVE
Persistent sepsis from an oesophageal perforation has a near 100% mortality. We describe our experience with early oesophageal diversion and exclusion for patients in-extremis.


METHODS
A retrospective review of oesophageal perforations was performed between 2000 and 2007. There were five cases Boerhaaves and one case of iatrogenic perforation that required oesophageal diversion and exclusion. 4 males, 2 females with a mean age of 67.6 (58-72) years.


RESULTS
The primary procedure was performed within 24h in four patients; the other two were after 3 and 10 days. The intensive care unit (ITU) stay was a median of 25 days. Mortality rate was 50%. Median length of stay for the survivors was 60 days. Three patients underwent a successful colonic interposition in our unit after 6 months.


CONCLUSIONS
Exclusion and diversion procedures are required in very rare circumstances. In conditions of persistent leak and continuing sepsis or those patients not fit to undergo a major procedure they could be lifesaving if performed early. As it is a relatively easy and quick procedure it should be considered early as a 2nd line management option.
Rohatgi
Ashish
A
Oesophagogastric Unit, St Thomas' Hospital, Westminister Bridge Road, London SE1 7EH, UK. ashroht@gmail.com
Papanikitas
Joseph
J
Sutcliffe
Robert
R
Forshaw
Matthew
M
Mason
Robert
R
D000368:Aged; D004939:Esophageal Perforation / Q000209:etiology / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies