Uncontained esophageal perforation is a devastating injury with a mortality rate approaching 20%. Early surgical repair supported by esophageal exclusion, early nutrional support, gastric drainage, and thorough pleural drainage should yield superior results.
The records of all patients treated esophageal perforations at one university medical center from 1988-2003 were collected and analyzed. Optimal treatment consisted of surgical repair, proximal esophageal and gastric decompression, thorough pleural drainage, initiation of nutritional support within 2 days, and IV antibiotics.
Forty patients were identified (37 adult and 3 pediatric). The age range was 0-87 years (mean 59.1). The male: female ratio was 1:1. Overall mortality rate primarily, had nasogastric suction, pleural and/or mediastinal drainage, and nutritional support. All had successful repairs with 0% mortality.Thirty-four patients had esophageal perforations in the distal two-thirds. Seven received conservative therapy of drainage, IV antibiotics, nutritional support, but no primary repair. Two died of continuing sepsis and five survived. Twenty-six patients were treated early with 11.5% mortality and 7 patients were treated late with 14.3% mortality. Twelve patients received suboptimal therapy with one or more of the major components of treatment being omitted. Four of these patients died (mortality rate 33.3%). Fifteen received optimal treatment with all of the major components with 0% mortality. Number of pleural and mediastinal drains placed was proportional to survival, with 4-6 drains yielding 0% mortality.
Prompt surgical repair supported by proximal esophageal exclusion without defunctionalization, gastric decompression, thorough pleural drainage, nutritional support within 2 days, and IV antibiotics yields excellent results in patients suffering from uncontained perforations of the distal two-thirds esophagus.
Early drainage and appropriate nutritional support yield excellent results in complex esophageal perforations.
Thomas Brown, None.