The Annals of Thoracic Surgery, Vol 23, 568-573, Copyright © 1977 by The Society of Thoracic Surgeons
The treatment of esophageal perforation with delayed recognition and continuing sepsis
JE Mayer Jr, CA Murray and RL Varco
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.
