The Diagnosis And Treatment Of Esophageal Perforation And Disruption

Background Esophageal perforation and disruption is a serious surgical emergency disease. This disease is extremely rare,and early symptoms of the disease are similar to those of emergency diseases of the chest and abdomen.The diagnosis and treatment are often delayed, resulting in an unfavorable outcome in some cases.Objective To study the clinical characteristics about the diagnosis,treatment of esophageal perforation and disruption,in order to improve the veracity of diagnosis and efficiency of treatment.Methods From May 1990 to February 2006, 42 patients of esophageal perforation or rupture were treated with surgical intervention and clinical data. The diagnosis, treatment and outcome of these patients were analyzed retrospectively.Results Diagnosis was confirmed in all patients by cheat X-rays, thoracentesis, and barium meal examination, In this series, there were 19 cases of spontaneous esophageal rupture, 7 of iatrogenic esophageal perforation, 11 of esophageal perforation caused by foreign body, 2 of traumatic perforation, 3 of advanced esophageal carcinoma with esophago-bronchial fistula. Managements included primary repair of esophageal perforation in 22 cases, esophagoectomy and eophagogaetro-anastomosis in 15 including 3 with failure of primary repair, chest drainage and jejunostomy in 4, the covered expandable metal stem in 2, cervicular drainage in 1, repair of eaophago and cervicular drainage in 1. 5 patients abandoned treatment. Postoperative results revealed cure in 30 patients, improvement in 4 and death in 3. Conclusions 1. A rapid but complete and accurate grasp of history, remaining high alert on the disease is the key to avoid misdiagnosis. 2. Complete collection of medical history, thoracentesis and esophageal roentgenograms are very helpful for the diagnosis. 3. Early diagnosis, Sufficient drainage and appropriate surgical treatments are the successful keys to increasing the curative effect and reduce the mortality rate. 24h is not the demarcation line to determine whether primary repair should be done. Primary repair is the first choice if the condition permit.