Diagnosis and treatment of esophageal perforation and disruption

Objective To improve the diagnosis and management of esophageal perforation and disruption. Methods Forty five cases of esophageal perforation or rupture were treated with surgical intervention and clinical data were analyzed retrospectively. Results Diagnosis was confirmed in all patients by chest X-rays, thoracentesis, barium meal examination and endoscopy. In this series, there were 15 cases of spontaneous esophageal disruption, 6 of iatrogenic esophageal perforation, 5 of traumatic perforation, 10 of advanced esophageal carcinoma with esophago-bronchial fistula, and 9 of esophageal diverticulum with esophago-bronchial fistula. Managements included primary repair of esophageal perforation in 9 cases, chest drainage and jejanostomy in 9 including one with failure of primary repair, esophagoectomy and esophagogastro-anastomosis in 12 including 3 with failure of primary repair, gastrostomy in 4, the covered expandable metal stent in 4, repair of esophago-bronchial fistula in 3, repair of esophago-bronchial fistula with lung lobectomy in 2, super-aortic arch esophago-gastmmy bypass in 1, cervicular drainage in 2. 3 patients abandoned treatment. Postoperative results revealed cure in 25 patients, improvement in 11 and death in 6. Conclusions Complete collection of medical history, thoracentesis and esophageal roentgenograms are very helpful for the diagnosis. Surgical closure of esophageal perforation as soon as possible and effective management of the primary esophageal lesion are the successful keys to the treatment of esophageal perforation or disruption.