[Esophageal perforation. Etiology, diagnosis, therapy]

Between 10/1997 and 2/2000 we treated eight patients (-66.5 y, 31-92 y, 5 male, 3 female). These cases were analyzed retrospectively.

In one case the the perforation was located in the cervical part, in three cases in the intermediate part, and in four cases in the distal part oesophagus. In seven cases the perforation was caused by endoscopic and one acid burn in suicidal intention. Surgical treatment was performed in seven cases (87.5%), five of them with primary suture, two with primary esophageal resection. The mortality rate was 50%. There was no insufficiency of the suture, but two patients died because of pulmonary complications, one patient with known hepatic cirrhosis (Child C) because of an uncontrollable bleeding of his fundus and esophageal complications 5 days after successful surgical treatment, and one patient because of fulminant sepsis after dislocation of an enteral catheter. Three of the patients were operated within 12 hours after perforation, seven of them were operated within less than 24 hours.

Surgical treatment of esophageal perforation within 24 hours after perforation shows good results. The outcome of the treatment depends on whether there are postoperative pulmonary complications and concomitant diseases. Enteral nutrition should be avoided in cases of primary esophageal resection to facilitate the surgical reconstruction at the second operation.