Spontaneous Oesophageal Rupture: An Evaluation of the Results of Treatment 1944-1969

Abstract

The results of treatment for spontaneous rupture of the normal oesophagus (Boerhaave syndrome) are discussed for the 25-year period 1944-1969. 221 cases in the literature are reported and one new case is added, all selected according to Mackler's definition. A thorough revision of 4 cases from thoracic units in Copenhagen within the period is given. 106 patients received thoraco-tomies, with a mortality of 34%. 37 received surgery within 12 hours and had a 22% mortality. 60% of conservatively managed patients died. 100% of patients receiving no treatment died. Average mortality for the material was 55%. Relating the time of death to treatment, it is found that death occurred within 7 days in half of those who died in the operated group as opposed to 66% in the conservatively treated group. 92% of the untreated group died within 48 hours. Errors in diagnosis and therapeutic evaluations are discussed. Only 15% of the material received thoracotomies within 12-15 hours. The various principles of treatment are discussed in the light of the present study. Proposals for a programme of treatment are presented in the conclusion.