title: Evaluation of urgent esophagectomy in esophageal perforation.
abstract: BACKGROUND
  Esophageal trauma is considered one of the most severe lesions of the digestive tract. There is still much controversy in choosing the best treatment for cases of esophageal perforation since that decision involves many variables. The readiness of medical care, the patient's clinical status, the local conditions of the perforated segment, and the severity of the associated injuries must be considered for the most adequate therapeutic choice.
  
  
  OBJECTIVE
  To demonstrate and to analyze the results of urgent esophagectomy in a series of patients with esophageal perforation.
  
  
  METHODS
  A retrospective study of 31 patients with confirmed esophageal perforation. Most injuries were due to endoscopic dilatation of benign esophageal disorders, which had evolved with stenosis. The diagnosis of perforation was based on clinical parameters, laboratory tests, and endoscopic images. ‪The main surgical technique used was transmediastinal esophagectomy followed by reconstruction of the digestive tract in a second surgical procedure. Patients were evaluated for the development of systemic and local complications, especially for the dehiscence or stricture of the anastomosis of the cervical esophagus with either the stomach or the transposed colon.
  
  
  RESULTS
  Early postoperative evaluation showed a survival rate of 77.1% in relation to the proposed surgery, and 45% of these patients presented no further complications. The other patients had one or more complications, being pulmonary infection and anastomotic fistula the most frequent. The seven patients (22.9%) who underwent esophageal resection 48 hours after the diagnosis died of sepsis. At medium and long-term assessments, most patients reported a good quality of life and full satisfaction regarding the surgery outcomes.
  
  
  CONCLUSIONS
  Despite the morbidity, emergency esophagectomy has its validity, especially in well indicated cases of esophageal perforation subsequent to endoscopic dilation for benign strictures.
authors: Hospital Celso Pierro, Faculdade de Medicina, Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil.
authors: José Luis Braga
authors: JL
authors: de Aquino
authors: Hospital Celso Pierro, Faculdade de Medicina, Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil.
authors: José Gonzaga Teixeira
authors: JG
authors: de Camargo
authors: Hospital Celso Pierro, Faculdade de Medicina, Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil.
authors: Gustavo Nardini
authors: GN
authors: Cecchino
authors: Hospital Celso Pierro, Faculdade de Medicina, Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil.
authors: Douglas Alexandre Rizzanti
authors: DA
authors: Pereira
authors: Hospital Celso Pierro, Faculdade de Medicina, Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil.
authors: Caroline Agnelli
authors: CA
authors: Bento
authors: Hospital Celso Pierro, Faculdade de Medicina, Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil.
authors: Vânia Aparecida
authors: VA
authors: Leandro-Merhi
mesh_terms: D000328:Adult; D000368:Aged; D004638:Emergency Treatment; D004939:Esophageal Perforation / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
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