Treatment of oesophageal perforation.

Abstract

The treatment of esophageal leaks is described. These leaks, if diagnosed within 6 to 12 hr. will heal well with thoracotomy and primary suture. Unfortunately, most cases are seen many hours after perforation, and are treated ''conservatively'' by thoracic ''toilet'' and drainage, and provision is made for continuous gastric aspiration and jejunal feeding with intensive antibiotic therapy during the first 10 days. The importance of adequate calorie intake with protein cover is stressed. Esophago-intestinal anastomotic leaks are treated conservatively. Spontaneous perforation of the esophagus that may present as an abdominal emergency is treated by direct suture or conservatively, depending on time elapsed since the perforation. Perforations of the lower esophagus may present-insidiously as a subphrenic abscess some days or weeks after instrumentation. Treatment consists in draining the subphrenic abscess. Leaks which occur following primary anastomosis of esophageal atresia are best treated by closure of the lower esophageal segment and exteriorization of the upper segment in the neck.