Nonoperative treatment of subcervical oesophageal perforations after forced dilatation for nonmalignant disease

Eight patients with perforation of the oesophagus following forced dilatation because of nonmalignant disease were treated conservatively with antibiotics and parenteral nutrition. None had primary leakage to the pleural cavities. Nasogastric suction was employed in three patients, and one had a feeding gastrostomy prior to perforation. Recovery was uneventful in six cases. A single thoracocentesis was required in one case. In the eighth patient there was leakage to the right pleural cavity with massive pleural effusion after two weeks of treatment and thoracotomy was necessary. All the patients survived. The authors conclude that subcervical oesophageal perforation following forced dilatation because of nonmalignant disease should be managed conservatively when there is no leakage to the pleural or peritoneal cavities.