Perforation of the oesophagus: experience in a general hospital

The results of a retrospective study of 62 patients who sustained perforation of the oesophagus during the period 1956--78 are reviewed. Oesophageal instrumentation was implicated in 40 patients. A total of 69 per cent of perforations occurred in the lower third; 45 per cent of patients remained undiagnosed for at least 24 h and in 23 patients remained undiagnosed for at least 24 h in 23 per cent the diagnosis was made only at post-mortem examination. Operative and non-operative management resulted in mortality rates of 48 per cent and 62 per cent respectively. Delay in operative treatment for more than 6 h was associated with increased mortality. However, 5 of 8 patients in whom diagnosis was delayed for more than 48 h recovered. The reason for this is discussed. The indications for conservative treatment are few and well defined; surgery is the treatment of choice. Early diagnosis and treatment are required if the mortality from oesophageal perforation is to be reduced.