Management of Instrumental and Spontaneous (Atraumatic) Perforations of the Oesophagus

Abstract

Twenty-one patients with perforation of the oesophagus were diagnosed and treated at the University Central Hospital of Turku in 1960-1969. Fourteen of them were instrumental and seven spontaneous perforations. In the cases of instrumental perforation the rupture generally occurred in connection with dilatation of lye stricture. In instrumental perforations the diagnosis was mostly delayed and treatment conservative. The mortality rate was 14% (2/14). In perforations caused by lye stricture conservative therapy led to a good result for the fixation of the environment and adhesions limited the spread of a mediastinal infection. In contrast, radical surgery should be the aim in other perforations, especially cases with residual distal obstruction. Two of the seven patients with spontaneous perforation died. Our results substantiate the view that early closure of spontaneous perforation should be aimed at. Although two patients were cured with pleural canalization alone, another two patients treated by the same method died. The three patients whose primary therapy consisted of thoracotomy and closure of the rupture recovered.