Surgical Treatment of Esophageal Perforation

Kim, Han Yong; Park, Jae Hong; Chei, Chang Seck; Kim, Dae Hwan; Hwang, Sang Won; Yoo, Byung Ha

Abstract

BACKGROUND: Perforation of esophagus is relatively uncommon. but it is associated with high morbidity and mortality. Treatment and outcome are largely determined by the time of presentation. We performed a retrospective review of patients with esophageal perforation to assess the outcome of current management techniques. MATERIAL AND METHOD: A retrospective chart review was performed on all patients treated for perforation of esophagus from March 1990 to March 2005. There were 28 patients (22 men and 6 women: mean age 51 years, range 17 to 82 years) The causes of the perforations were as follows: foreign body retention (9 patients), trauma (7 patients), spontaneous rupture (7 patients), and iatrogenic (5 pati-ients). 18 patients were presented within 24 hours and 10 patients were presented after 24 hours. Esophageal repair was performed in 21 (75%) of them, 4 patients were treated with esophagectomy, 3 patients were treated with feeding gastrostomy and drainage. RESULT: Hospital mortality was 18% and iatrogenic was increase the mortality rate (p <0.05). Site of perforation, time from perforation, and treatment method had no influence on mortality. Postoprative leaks occurred in 4 patients after primary repair and were treated conservatively.
CONCLUSION
Esophageal perforation remains a devastating event which is difficult to diagnose and manage. Primary repair can be performed in most patients with esophageal perforation regardless of time to presentation with a low mortality. Accurate diagnosis and early treatment are essential to the successful managenent of patients.