[Management of thoracic esophageal perforation]

To compare surgical management of esophageal perforation on thoracic portion with nonoperative management.

Seventeen patients were treated for thoracic esophageal perforation at our department between 1962 and 1996. Among them, seven patients underwent nonoperative management. The remaining 10 had operative procedures (primary repair in 5, esophagostomy in 3, and drainage alone in 2 cases).

Postoperative leakage occurred in 2 patients; among the two leakages, 1 required cervical esophagostomy, and 1 became a controlled fistula needed pleural drainage and feeding jejunostomy. One patient had anastomotic narrowing after esophagostomy. Of patients with nonoperative management, five survived (with 28% in-hospital mortality rate), Whereas only one patient, who was treated by surgical procedure, died (with 10% inhospital mortality rate). The mean hospital stay in nonoperative and operative group were (28.3 +/- 12.9) days and (57.6 +/- 52.7) days respectively.

The clinical observation suggested that rapid diagnosis of thoracic esophageal perforations is essential and once the diagnosis of esophageal perforation is established, a appropriate management must be selected promptly.