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Ann Thorac Surg 1992;53:534-543
© 1992 The Society of Thoracic Surgeons
Division of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, and Division of Cardiothoracic Surgery, Cornell University Medical College, New York, New York USA
* Address reprint requests to Dr Ginsberg, Division of Thoracic Surgery, Memorial Sloam-Kettering Cancer Center, 1275 York Ave, New York, NY 10021 USA.
Perforation of the esophagus remains a diagnostic and therapeutic challenge. Currently, the most common cause of perforation is instrumentation of the esophagus, and the incidence of esophageal perforations has increased as the use of endoscopic procedures has become more frequent. Diagnosis depends on a high degree of suspicion and recognition of clinical features, and is confirmed by contrast esophagography or endoscopy. Outcome after esophageal perforation is dependent on the cause and location of the injury, the presence of underlying esophageal disease, and the interval between injury and initiation of treatment. Reinforced primary repair of the perforation is the most frequently employed and preferable approach to the surgical management of esophageal perforations. Nonoperative management consisting of antibiotics and parenteral nutrition is particularly successful for limited esophageal injuries meeting proper selection criteria.
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