Perforation and rupture of the esophagus

A series of 57 esophageal perforations from the period 1963-1982 is reported. They comprised 42 iatrogenic, instrumental perforations and 15 non-iatrogenic, mainly spontaneous and postemetic ruptures. The clinical manifestations were mostly pain, fever, subcutaneous and mediastinal emphysema, pleural effusion and pneumothorax. Esophageal leak was demonstrated in 73% of contrast studies. The overall mortality rate was 25%. It was 21% in cases with primary suture closure and 50% when treatment consisted of drainage. The mortality rate was 19% when treatment was begun within 24 hours and 35% when there was longer delay. Other factors influencing the mortality rate seemed to be type and location of the perforation and age of the patient. Early surgical intervention is advocated for perforation or rupture of the intrathoracic esophagus. Data in the literature and our own findings indicate that also in cervical esophageal perforations early surgical repair is justifiable.