HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Sunil K. Ohri Vivek Pathi Edward R. Townsend Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ohri, S. K. Articles by Fountain, S. W. Search for Related Content PubMed PubMed Citation Articles by Ohri, S. K. Articles by Fountain, S. W.

Ann Thorac Surg 1993;55:603-606
© 1993 The Society of Thoracic Surgeons

---

Articles

Primary repair of iatrogenic thoracic esophageal perforation and Boerhaave's syndrome

Department of Thoracic Surgery, Harefield Hospital, Harefield, Middlesex, United Kingdom

Accepted for publication June 2, 1992.

^_* Address reprint requests to Mr Ohri, Cardiothoracic Unit, Dept of Surgery, Royal Postgraduate Medical School, Hammersmith Hospital, London W12 OHS, England.

Ten patients seen at our unit over a 24-month period with either iatrogenic (n = 5) or spontaneous thoracic esophageal perforations (n = 5) were retrospectively reviewed. Five patients were seen within 24 hours of onset of symptoms, and 5 were seen after 24 hours or later. There was no significant difference in the presentation or subsequent clinical course in patients seen less or more than 24 hours after the onset of symptoms. Nine patients underwent primary repair together with drainage of the mediastinum, and in 1 of these a Heller's myotomy was also performed for achalasia. One patient had a twostage esophagogastrectomy for a benign esophageal stricture. One patient (10%) with a spontaneous perforation died 48 hours after operation and was found at postmortem examination to have an in situ carcinoma at the site of the perforation. Four patients (40%) had nonfatal complications. Fistulas developed in 3 patients (30%); in 1 of these patients a second thoracotomy and a further rib resection was required for drainage of a mediastinal abscess. An esophagocutaneous fistula and a persistent mediastinal abscess developed in 1 patient (10%) and necessitated two further thoracotomies for effective drainage. The mean hospital stay was 38.4 ± 25.4 days (range, 16 to 76 days). The findings of this study suggest that primary repair combined with a drainage procedure is the treatment of choice for patients with a perforated intrathoracic esophagus, including those seen more than 24 hours after the onset of symptoms.

This article has been cited by other articles:

				D. J. Minnich, P. Yu, A. S. Bryant, D. Jarrar, and R. J. Cerfolio Management of thoracic esophageal perforations Eur J Cardiothorac Surg, October 1, 2011; 40(4): 931 - 938. [Abstract] [Full Text] [PDF]

				J. S. Cho, Y. D. Kim, H. I, S. K. Lee, and Y. J. Jeong Treatment of mediastinitis using video-assisted thoracoscopic surgery Eur J Cardiothorac Surg, September 1, 2008; 34(3): 520 - 524. [Abstract] [Full Text] [PDF]

				C. J. Brinster, S. Singhal, L. Lee, M. B. Marshall, L. R. Kaiser, and J. C. Kucharczuk Evolving options in the management of esophageal perforation Ann. Thorac. Surg., April 1, 2004; 77(4): 1475 - 1483. [Abstract] [Full Text] [PDF]

				J. Jougon, T. Mc Bride, F. Delcambre, A. Minniti, and J.-F. Velly Primary esophageal repair for Boerhaave's syndrome whatever the free interval between perforation and treatment Eur J Cardiothorac Surg, April 1, 2004; 25(4): 475 - 479. [Abstract] [Full Text] [PDF]

				D. R. Lawrence, S. K. Ohri, R. E. Moxon, E. R. Townsend, and S. W. Fountain Primary esophageal repair for Boerhaave's syndrome Ann. Thorac. Surg., March 1, 1999; 67(3): 818 - 820. [Abstract] [Full Text] [PDF]

				B. L. Bufkin, J. I. Miller Jr, and K. A. Mansour Esophageal Perforation: Emphasis on Management Ann. Thorac. Surg., May 1, 1996; 61(5): 1447 - 1451. [Abstract] [Full Text]

				N. Wang, A. J. Razzouk, A. Safavi, K. Gan, G. S. Van Arsdell, P. M. Burton, B. L. Fandrich, M. J. Wood, A. C. Hill, E. E. Vyhmeister, et al. DELAYED PRIMARY REPAIR OF INTRATHORACIC ESOPHAGEAL PERFORATION: IS IT SAFE? J. Thorac. Cardiovasc. Surg., January 1, 1996; 111(1): 114 - 122. [Abstract] [Full Text]

				C. D. Wright, D. J. Mathisen, J. C. Wain, A. C. Moncure, A. D. Hilgenberg, and H. C. Grillo Reinforced primary repair of thoracic esophageal perforation Ann. Thorac. Surg., August 1, 1995; 60(2): 245 - 249. [Abstract] [PDF]

				J. P. Clarke Thoracic esophageal perforations Ann. Thorac. Surg., September 1, 1993; 56(3): 595 - 596. [PDF]