[Early diagnostic pitfalls in esophageal perforation and spontaneous rupture of the esophagus]

In this retrospective study (1981-1993) of 31 cases of esophageal perforations and ruptures circumstances the delay or misdiagnosis with undoubtable influence on the survival have been discussed. The over-all mortality was 16.1% but in cases of early (24 h) perforations or ruptures (12) no patients were lost. The unfavourable consequence of the superficial case history, underestimated pain, incomplete roentgenographic study, diagnostic confusion inadequate surgical exploration and misinterpreted postoperative complications of the formal esophageal surgery are analyzed. The authors emphasized the methods to decrease the number of the false-negative contrast esophagograms as well as the value of the intraoperative endoluminal diluted methylin-blue injection to detect esophageal leak. The early diagnosis is the first prerequisite for a favourable outcome in this life-threatening emergency.