[Omental implantation technique for esophageal perforations--a clinical case and experimental studies]

We successfully used the omental implantation technique in a case of esophageal perforation in which simple closure was impossible because of extreme inflammatory changes. Although excellent results have been obtained by this method in gastroduodenal perforations, it has never been used before in cases of esophageal perforations. In this study we subsequently investigated the histological repair mechanism by carrying out animal experiments. Clinical case A 59-year-old male entered our hospital with the symptoms of chest pain and fever after endoscopic therapy for esophageal obstruction by food impaction. He underwent an emergency thoracotomy 54 hours after endoscopy. A perforation of about 2 cm in diameter was observed in the subthoracic esophageal wall which become too weak to close by stitching. This perforation was filled with an omental plug inserted from the peritoneal cavity under laparotomy. The patient recovered and his perforated lesion was completely repaired. Animal experiment In 10 hybrid adult dogs, omental implantation was performed on perforations of more than 1 cm in diameter in the subthoracic esophagus made by electric coagulation. One to four weeks postoperatively, these inserted omentums were observed endoscopically before sacrifice. The implanted omentums were endoscopically observed as elevated lesions after 2 weeks, but they became flat after 3 weeks and the mucosa seemed to be almost normal after 4 weeks. Histological investigation showed that the implanted omentums maintained their original structure accompanied by remarkable inflammatory changes 1 week postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)