The management of non-neoplastic esophageal perforation

The clinical features, management and prognosis of non-neoplastic esophageal perforation are evaluated in a clinical series of 29 patients. Five of 12 spontaneous ruptures were caused by vomiting after alcoholic intake. There were 12 iatrogenic perforations, five of which were caused by esophageal dilatation, four by diagnostic endoscopy and three by endoscopic removal of foreign bodies. Most cases were diagnosed by esophagogram. The delay in reaching the right diagnosis was less than 12 hours in 11 cases and more than 48 hours in ten cases. Management was surgical in 25 cases and conservative in four cases. The operative procedures used were direct suture closure in 15 cases, drainage in eight cases and esophageal resection in two cases. The overall mortality rate was 24%. Ten out of 11 perforations treated surgically within 12 hours of the perforation were cured and seven of 15 patients treated by primary closure recovered without complications.