Abstract AGGRESSIVE surgical attack is the accepted conservative management of esophageal perforation. Since Barrett1 first reported his successful treatment of a patient in 1947, the accepted concept of therapy of esophageal perforation has been drainage, primary repair of this perforation, if possible, bypass of esophageal function (gastrostomy), and high dosage of antibiotics. Recent advocates of nonsurgical management of esophageal perforation have prompted us to review our experience with the problem over the last four years at local community hospitals. Twelve consecutive cases of esophageal perforation were reviewed and form the basis of this report (Table). Of these, six followed esophagoscopy by qualified endoscopists, two resulted from foreign body ingestion, two followed transabdominal repair of hiatal hernia, one was spontaneous, and the other followed retrograde dilatation of esophageal stricture. Another case (foreign body perforation) involved an 83-year-old patient. The condition was discovered at autopsy and is not included. Diagnosis and Report References 1. Barrett, N.R.: Report of a Case of Spontaneous Perforation of the Esophagus Successfully Treated by Operation , Brit J Surg 35:216, 1947.Crossref 2. Neuhof, H., and Jemerin, E.: Acute Infections of the Mediastinum , Baltimore: Williams & Wilkins Co., 1943. 3. Samson, P.C.: Postemetic Rupture of the Esophagus , Surg Gynec Obstet 93:221, 1951. 4. Overstreet, J.W., and Ochsner, A.: Traumatic Rupture of the Esophagus , J Thorac Surg 30:164, 1955. 5. Groves, L.K.: Instrumental Perforation of the Esophagus , J Thorac Cardiov Surg 52:1, 1966. 6. Foster, J.H., et al: Esophageal Perforation , Ann Surg 161:701, 1965.Crossref 7. Mengoli, L.R., and Klassen, K.P.: Conservative Management of Esophageal Perforation , Arch Surg 91:238, 1965.Crossref 8. Nealon, T.F., Jr., et al: Instrumental Perforations of the Esophagus , J Thorac Cardiov Surg 41:75, 1961.
Archives of Surgery – American Medical Association
Published: Mar 1, 1968