Management of instrumental perforations of the esophagus

M. G. Sarr, J. H. Pemberton, W. S. Payne

Research output: Contribution to journalArticle

84 Scopus citations

Abstract

Experience with 47 consecutive instrumental perforation of the esophagus is described. Perforation occurred in the cervical esophagus in 18 patients, mid-thoracic esophagus in 12, and distal esophagus in 17. The majority of patients (87%) harbored a primary esophageal disorder necessitating esophageal instrumentation. Eight select patients were treated nonoperatively with one death; however, some form of morbidity with prolonged hospital stay occurred in half of these patients. In contrast, 39 patients underwent emergency surgical intervention. Only one death occurred in the 31 patients treated by local drainage and attempted closure of the perforation. However, three of six patients with distal perforations treated by esophageal resection with primary esophagogastrostomy died in the early postoperative period. Our results suggest that most instrumental perforations of the esophagus should be managed surgically. Drainage and closure of cervical perforations yields goods results. Esophageal resection with primary reconstitution of esophagogastric continuity should be reserved for select situations. Nonoperative management might be entertained in minimally symptomatic patients harboring a late, locally contained perforation without signs of ongoing sepsis.

Original languageEnglish (US)
Pages (from-to)211-218
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume84
Issue number2
DOIs
StatePublished - 1982

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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