Spontaneous rupture of the esophagus: immediate and late results

The management of spontaneous rupture of the esophagus (SRE) is still somewhat controversial, but primary repair, with or without suture line plication, remains the backbone of therapy. Although the short-term results of the surgical therapy of SRE have been widely published, reports of the long-term follow-up have been scarce. The short- and long-term results of the treatment of 18 patients presenting with SRE over the sixteen-year period, 1971-1987, are reviewed. The general approach has been to perform a primary repair, with or without suture line plication, depending on whether, after debridement, the tissues appear adequate enough to hold sutures. Fifteen patients underwent primary repair. One patient underwent cervical esophagostomy in continuity and exclusion of the repair. One was managed with chest tube drainage, while another was treated with T-tube drainage of the rupture. Those undergoing surgery within 12 hours of rupture are termed "early" (E), all others "late" (L). Eight primary repairs were plicated with gastric fundus with six recoveries (three "E", three "L"); three with a pleural flap with one recovery (one "L"); and four were not plicated with three recoveries (two "E," one "L"). Follow-up with esophagogram in eight of 11 survivors ranged from 6 weeks to 8 years (mean 28 months). Four patients with fundoplication and one without plication had normal esophagography. Two patients with fundoplication had stricture in the lower esophagus. In both, the fundoplicated segment had been left above the diaphragm. The patient whose repair was excluded just above the stomach had stenosis at that level. Three of the 11 survivors were lost to follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)