PERFORATION OF THE ESOPHAGUS A 12-YEAR EXPERIENCE

Esophageal perforation continues to be a difficult diagnostic and management problem. Recommendations regarding treatment remain controversial. 17 patients with perforation of the esophagus were retrospectively reviewed at the Thoracic Surgery Unit of Imam Khomeini Hospital between 1981 and 1992. The majority of the injuries involved the thoracic esophagus (10 or 59%), followed by the cervical (6 or 35%), and the intra-abdominal esophagus (1 or 6%). Perforations caused by external trauma constituted most of the injuries (47%), followed by ingested foreign bodies (29%), iatrogenic causes (18%), and spontaneous perforation (6%). Excluded from this study were patients with tracheoesophageal fistulas, postoperative esophageal anastomotic leaks, and perforations due to esophageal carcinoma. Esophageal radiographic contrast studies with either Gastrografin or barium were performed in 11 patients with 2 (18%) false-negative results. Fever, chest pain, dysphagia, dyspnea and crepitus were common clinical findings. 2 patients (12%) were treated conservatively, 3 (18%) by primary repair and drainage, and 12 (70%) by drainage and diversion with or without exclusion. The author puts great emphasis on mediastinal drainage and irrigation in addition to diversion in late diagnosed cervical or thoracic esophageal perforations with pleural and mediastinal contamination.