Management of oesophageal perforations; a tailored approach

The results of treatment of 20 oesophageal perforations were retrospectively studied in 19 consecutive patients. Most complications occurred after endoscopic procedures, after a delay in treatment of more than 12 hours, in patients with intrinsic oesophageal disease and in cases where only drainage procedures were possible. Because of the many factors that influence the outcome of the treatment of oesophageal perforation it is stressed that the therapeutic approach should not be dogmatic, but tailored to the individual patient. Although morbidity is still high, mortality has markedly decreased by this differentiated approach, the only death not being directly related to the perforation. Early recognition remains the most important factor in the prognosis of patients with oesophageal perforation.