To evaluate the results of treatment of esophageal perforations from all causes we retrospectively studied medical records of 197 patients treated in the setting of a single institution during the last 20 years. The majority of injuries involved the thoracic esophagus (127 or 64,5%), followed by the cervical (68 or 34,5%) and the abdominal (2 or 1%) esophagus. Iatrogenic causes of injuries were the most common (121 or 61,4%), followed by ingested foreign bodies (39 or 19,8%), blunt or penetrating external trauma (26 or 13,1%) and spontaneous rupture (11 or 5,6%). At the initial presentation 33 patients had chronic sequelae of esophageal perforation (chronic arm), whereas 164 patients were treated immediately after trauma episode (acute arm). 30 patients had associated injuries of the esophagus and the trachea. At the acute arm 18 (9,1%) patients were managed nonoperatively according to the Cameron's criteria Cervical perforations were treated with primary reinforced closure by pedicled muscle nap. Several procedures were used for thoracic perforations. A mortality rate was 7,3% (12 patients) at acute arm. There was no mortality at chronic arm. The most common causes of mortality were multiple organ failure and bleeding. Thoracic perforations were more lethal than cervical perforations (mortality 9.5% vs 0%). The results of treatment of esophageal perforation as potentially lethal condition depend upon prompt diagnosis and the interval between injury and initiation of surgical treatment A method of treatment depends on the underlying pathology of the esophagus with mandatory primary reinforced closure of all the perforations of healthy esophagus. Patients with spontaneous rupture and perforation of the thoracic esophagus may do worse. During the last 20 years 197 patients with mean age 41 years (range 1,5 - 78) have been treated for transmural esophageal perforations. Male/Female ratio was 137/60. All the patients were broken into two treatment arms. Patients of the first group were treated immediately after their esophageal trauma (acute arm), whereas those of the second group had chronic sequelae of esophageal perforation (chronic arm). The causes of esophageal perforation are depicted in Figure 1. Iatrogenic perforation was the most common (121 or 61,4%) (Figure 2). Perforations of the thoracic esophagus (ThE) have occurred more often (127 or 64,5%) than those of the cervical esophagus (68 or 34,5%) (CE) and the abdominal esophagus (2 or 1%) (AE). 125 patients had perforations on the basis of benign stricture of the esophagus and 2 patients - spontaneous perforation of esophageal cancer, whereas no underlying pathology of the esophagus was present in 70 (35,5%) patients. Diagnostic workup in all the patients included plain and lateral films of the chest and the neck and esophagography with a water - soluble contrast medium. We used esophagoscopy for the foreign body extraction preoperatively, and to precise the diagnosis either in minimal perforation or negative esophagogram. Flexible bronchoscopy, esophagoscopy and tomography of the trachea were performed to evaluate chronic sequelae of associated injuries of the esophagus and the trachea. We have accepted the Cameron's criteria (1,2) of nonoperative treatment of esophageal perforation. 18 (9,1%) patients were treated in such a way, including 2 patients with spontaneous perforation of esophageal cancer. Both the patients died within 72 hours after their admission with one tumor being overlooked. This patient was presented with right - sided loculated empyema with no symptoms of dysphagia, and the diagnosis was established at autopsy. Surgical treatment of esophageal perforation goes through a sequence of stages.
