Thoracic esophageal perforation

Perforation of the esophagus is a deadly injury that requires expert management for survival. We performed a retrospective clinical review of 84 patients (44 men, 40 women) treated at "Miquel Perez Carreno" University hospital, Caracas, with thoracic esophageal perforation, between 1979 and 1999, in order to determine this most appropriate management. In 62% treatment was performed within 24 hours. In the rest (48 patients) the mean delay was 6,3 +/- 1,3 (2-8) days. In 27,38%, the perforation was confined to mediastinum and conservative treatment was provided. Of the total patients, 4 developed empyema and underwent esophageal resection. Extramediastinal involment was confirmed in 72,62% patients and was treated by a variety of surgical procedures: esophagectomy ( n= 11), drainage alone (n =4), primary closure (n= 10), and reinforced primary repair (36). Three patients with simple closure and one with reinforced primary closure developed leakage of the suture line resulting in death. All patients who underwent esophagectomy survived. In patients with perforation confined to mediastinum, mortality was O%, whereas in those with extramediastinal involment mortality was 11,5%. Thoracic esophageal perforation leads to high mortality rates and requires early diagnosis and immediate treatment.