[Management of acute oesophageal fistulas (author's transl)]

The observation of 75 patients with acute oesophageal fistulas indicate their great multiformity of etiology, pathogenesis, morphology, clinical course, complications, underlying oesophageal pathology. Most frequently the fistulas resulted from injuries inflicted during bouginage, cardiodilatation, external and intraoperative trauma. Drug therapy should be started immediately with the making of diagnosis of the suspected oesophageal injury, and then surgery is undertaken if indicated. Drug therapy proved effective only in cases of non deeply penetrating injuries. Palliative interventions as sole procedures permitted to eliminate the acute fistulas in 12 patients, to turn them into chronically behaving--in 17; in the rest of the patients they were ineffective. Twenty-one patients were operated radically, 9 of them following ineffective drug therapy and palliative surgery. The result of radical surgery depends on several factors, and especially on its technique, on the reinforcement and isolation of the sutures by the adjacent tissues with blood supply preservation--diaphragm, pericardium, pleura, muscle-pleural flap, muscles, etc.