Oesophageal resection after instrumental perforation

Between 1981 and 1987, 11 patients underwent oesophageal resection following endoscopic perforation of the oesophagus. They had a median age of 67 years with a range of 36 to 88 years. They all were managed either by one- or two-stage oesophageal resections. Six patients were perforated at other hospitals, 5 on site. Seven had carcinoma of the middle or lower third of the oesophagus, 2 of these were perforated at attempted palliative intubation. Four had benign peptic strictures perforated during dilatation. Seven were resected within the first 24 hours and 4 between 2 and 10 days after perforation. All 4 patients with benign disease survived but 4 of the 7 patients with cancer died giving an operative mortality of 36.3%. Respiratory complications were the most common postoperative problem: all deaths were attributed to respiratory failure. Perforation of the thoracic oesophagus carries a high mortality. Resection after perforation in benign strictures may be life saving in a potentially lethal condition but resection after perforation, even in operable cancer, still carries a high mortality.