Surgical treatment of traumatic esophageal perforations: analysis of 10 cases.

PURPOSE Traumatic esophageal perforations are infrequent. They represent a surgical dilemma for surgeons, especially if diagnosis is made late. Recently, it has been reported that mortality due to perforation of the esophagus has diminished independently of time of presentation. The experience with traumatic perforations of the esophagus is reviewed to determine morbidity-mortality and how it is affected by time. METHODS A retrospective clinical review was made of all patients with a diagnosis of traumatic perforation of the esophagus treated by the author. There were 10 patients, all of them male. Average age was 32 years (range 17 to 63). The cause of trauma was gunshot (7), blunt trauma (1) and foreign body (2). Four patients were treated within 24 hours of injury (early treatment). Treatment of 6 patients was delayed 56 to 168 hours after the injury (delayed treatment). RESULTS Patients treated early underwent primary repair. Delayed treatment included: primary repair (1), T-tube (2), drainage of cervical abscess and pulmonary decortication (2), and conservative treatment (1). There was 1 death in the delayed group (16.6%). One patient in the early treatment group (25%); 4 (66%) in the delayed treatment group had complications. Postoperative stay in the hospital was an average of 20.5 days for the early treatment group and 38 for the late treatment group. CONCLUSIONS Mortality of traumatic esophageal perforations has diminished significantly. Morbidity, particularly in delayed treatment, is still very high, with multiple operations and prolonged stays in intensive care units and surgical wards, resulting in high hospital costs. The main factor that seems to influence mortality-morbidity of traumatic esophageal perforations is the time of diagnosis. Every effort should be made to diagnose these injuries early. Once diagnosis is made, treatment should be aggressive and expeditious.