Oesophageal perforation--a review of 37 cases

We have reviewed 37 cases of ruptured oesophagus treated at St Vincent's Hospital from 1976 to 1986. Their age ranged from 20 to 89 years (mean 64 years) and 59% were female. The causes of rupture were spontaneous (9), foreign body (5), diagnostic oesophagoscopy (8), oesophagoscopy and dilatation (5), balloon dilatation (3), palliative intubation (6) and patient self dilation (1). Eighty-six per cent of perforations occurred in the lower third of the oesophagus. The most common means of diagnosis was a positive contrast swallow (90%) and/or the presence of cervical or mediastinal air (49%). Eighteen patients underwent surgical treatment which consisted of a combination of thoracotomy, drainage and repair, or laparotomy and Celestin tube insertion, with or without chest drainage. Two patients underwent oesophageal diversion. The overall mortality in all patients was 30% (37% non-operative and 22% operative group). We conclude that the management of ruptured oesophagus demands an individual approach depending upon the site and aetiology of perforation and the underlying disease. The condition is a disease of the elderly and continues to have a high morbidity and mortality.