Intrathoracic oesophageal perforations following bougienage: a protocol for management

Perforation of the thoracic oesophagus is a serious complication of oesophagoscopy and bougienage for oesophageal strictures. In the last 7 years, 10 such cases have been treated without mortality by following a particular treatment protocol. Irrespective of the duration of perforation, extent of contamination or severity of symptoms, all patients underwent thoracotomy for pleuromediastinal toilet and drainage. Decompressive gastrostomy and feeding jejunostomy was done and a nasogastric tube was left across the stricture to serve as a stent. A thread attached to the nasogastric tube helped in retrograde dilatation after healing of perforation. Infection was controlled with intravenous gentamicin, cloxacillin and metronidazole. In all patients, the perforation healed. Colonic transposition was done in three cases at a later date. The rest required periodic dilatation of the oesophagus either by peroral or retrograde approach.