Surgical management of late esophageal perforation

Over sixteen years we have gained experience in the delayed surgical management of esophageal rupture in nine patients who received treatments more than 24 hours after perforation. The causes of perforation were Boerhaave's syndrome or barotrauma in four patients, foreign bodies in two, and other causes in three. Three patients presented in septic shock and four in respiratory failure. Three surgical options were used for treatment: simple thoracic drainage in two patients, T-tube placement in four, and esophagectomy with secondary reconstruction in three. Eight patients (89%) survived. T-tube placement was effective in that it was a one-stage operation which could be used on severe esophageal injuries in patients in poor general condition. Three patients who underwent esophagectomy and secondary alimentary restoration required long hospital stays (119,201, and 648 days). Although the number of cases is small, T-tube insertion for the late management of esophageal rupture appears to be a simple and effective method which avoids the postoperative complications associated with primary closure or two-stage operations.