Perforation of the esophagus

For the period 1993 through 2001 a retrospective clinical analysis of 22 patients with perforation of the esophagus was conducted. All patients received treatment at the Clinic of Thoracic and Abdominal Surgery, St. George University Hospital, Plovdiv. Perforation of the esophagus had several causes: instrumentation (upper endoscopy and dilatation) in 12 patients (54.5%), foreign bodies in 5 patients (22.78%) and trauma in 3 (13.64%). Spontaneous rupture was observed in 2 cases (9.10%). Surgical treatment was used in 20 patients (90.90%), 2 patients (9.10%) received conservative treatment. In 12 patients surgery was performed within 48 hours following esophageal rupture, 8 patients received surgical treatment after 48 hours. Surgical procedure included: esophageal repair using soft tissue (pleural or diaphragm) vascular flaps. Of all patients 9 fatalities were registered--3 patients died within the first 48 hours following surgery, 5 died after 48 hours. Death occurred in one case among conservatively treated patients. On the basis of the accumulated evidence it is concluded that early diagnosis, prompt surgical treatment and prevention of postoperative complications result in improved treatment outcome.