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Ann Thorac Surg 1977;23:568-573
© 1977 The Society of Thoracic Surgeons

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Articles

The Treatment of Esophageal Perforation with Delayed Recognition and Continuing Sepsis

From the Department of Surgery, University of Minnesota and the Minneapolis Veterans Administration Hospital, Minneapolis, MN

Accepted for publication December 1, 1976.

^* Address reprint requests to Dr. Mayer, Surgical Service, Veterans Administration Hospital, 54th St and 48th Ave S, Minneapolis, MN 55417

Five patients, recently treated for esophageal ruptures, provided a spectrum of "late" perforations. Treatment was individualized for each patient and ranged from suture closure of the perforation to esophagectomy. Four of the 5 patients survived and now have no dietary restrictions.

The goals of treatment should be: (1) elimination of sources of chemical and bacterial soilage; (2) drainage of infected areas; (3) augmentation of host defenses by antibiotics; and (4) provision of adequate nutrition. Several treatment adjuncts, alone or in combination, may be used to accomplish these goals. The selection of treatment methods should be influenced by the site of perforation, the extent of local inflammation, the status of the residual esophagus, the overall status of the patient, and the chronicity of the perforation. As the risk of uncontrolled sepsis increases, the surgeon should take more aggressive and definitive steps, up to and including esophagectomy in certain cases, to prevent further soilage.

This article has been cited by other articles:

				A. E. Flynn, E. D. Verrier, L. W. Way, A. N. Thomas, and C. A. Pellegrini Esophageal Perforation Arch Surg, October 1, 1989; 124(10): 1211 - 1215. [Abstract] [PDF]

				S. E. Vernon and G. P. Carmichael Jr Unsuspected Esophageal Perforation JAMA, December 1, 1978; 240(23): 2568 - 2569. [Abstract] [PDF]