[Perforations of the esophagus]

The prognosis of esophageal perforations remains poor. In this study 80 cases (26 cervical, 45 thoracic and 9 abdominal) are reported. Pain was the most frequent symptom, present in 56/80 cases. Signs of perforation were detected on standard X-ray films in 85% of the cases, and oesophagography with Hytrast showed a leak in 88%. Treatment was delayed for more than 24 hours in 41 patients. Direct intervention on the esophageal wound (suture, fistulization, drainage, double exclusion, resection) was carried out in 54 patients, whereas 26 were fed parenterally or by tube or through jejunostomy and were given antibiotics with or without drainage of a fluid collection. The overall mortality rate was 35%, death being caused by infection or toxic shock. Treatment and prognosis were dependent upon the course of the infection. No other single prognostic factor was significant, with the exception of age over 60.