Treatment of iatrogenic oesophageal perforation diagnosed with delay

The number of iatrogenic perforations of the oesophagus has increased during the last decade and the condition still carries a high morbidity and mortality. The mortality increases considerably if treatment is delayed for more than 24 hours. In our department all patients with iatrogenic perforation of the thoracic oesophagus are treated in the same way: antibiotics and gastric decompression followed by thoracotomy with cleavage of the mediastinum and closure of the defect if it can be visualized and if the oesophageal wall is vital. During the last decade we have treated 15 patients in whom treatment was delayed for more than 24 hours. Two of the patients (13%) died during the postoperative course. We find that our strategy is associated with a low mortality.