Nonoperative Management of Contained Esophageal Perforation

Spontaneous perforation of the esophagus still carries a high rate of morbidity and mortality because of frequent delay in diagnosis, extensive mediastinal contamination, and inadequate surgical repair. We used a nonoperative approach in two patients in whom the perforation was well contained, with evidence of drainage back into the esophagus and few symptoms or signs of sepsis. Nonoperative management included administration of intravenous antibiotics and hyperalimentation. Both patients had a satisfactory outcome.