[Transmural esophagus perforation. Experiences with conservative treatment]

We report on four cases of esophageal perforation - self-induced, iatrogenic and spontaneous (Boerhaave's syndrome) - treated successfully by conservative means. Based on our own experience and the data collected from the literature the clinical findings, symptoms and signs, prognosis and therapeutic guidelines are reviewed. As a general rule every esophageal perforation diagnosed within the first 24 hours should be treated surgically. After the 24-hour limit the mortality in both surgically and conservatively treated patients runs parallel. Conservative treatment is based on absolute exclusion of oral ingestion, broad-spectrum antibiotics and adequate drainage of pleural empyema and abscesses.