[Unusually late presentation esophageal perforations and ruptures]

The aim of this study is to present the treatment modalities of unusual late esophageal perforations and ruptures. The reason for diagnostic delay was misinterpretation of pleural collection, overlooked sclerotherapy, foreign body extraction, and delayed recognition of the true origin of empyema after pneumonectomy. In all instances of transthoracic reinforced or temporary excluded primary repair were successful. In a 6- week-old iatrogenic perforation with localised empyema, Urschel-Ergin type exclusion with tube thoracostomy and lavage was used. In a 13-day-old rupture, and in a late postpulmonectomy perforation, Johnson type exclusion, decortication, and/or fenestration and second-stage colonic or Roux-en-Y by-pass were carried out. One patient was lost in deep sepsis for a delayed recognised transfixion esophageal injury. It is never too late to attempt to repair and salvage a perforated or ruptured healthy esophagus.