[Perforation of the esophagus. Diagnosis and treatment. Analysis of 20 cases]

The experience on perforation of the esophagus at the Hospital Infantil de México is reviewed. Between 1961 and 1975, 20 cases were attended. The most frequent perforation is the iatrogenic subsequent to dilatations or to esophagoscopy. Esophageal perforation is the most serious of the digestive tube perforations and must be considered as a real medicosurgical emergency. The clinical picture is analyzed and the necessity to take chest x-rays and esophagogram as urgent measures is emphasized at the slightest clinical doubt. The different treatment methods are mentioned and it is stressed that the best results are obtained with an urgent thoracotomy, closure of the perforation, full canalization and antibiotic therapy at high doses. According to the literature referred and to the results obtained from the present study, mortality is higher in cases where treatment is delayed. The clinical and radiological pictures are described together with the therapeutic behavior in spontaneous perforation in the newborn. The theories to explain this etiology are set forth. At present, mortality is still high; therefore, in order to bring down this high percentage, it is concluded that an early diagnosis together with an agressive surgical treatment are necessary.