Recognition and Treatment of Esophageal Perforations *

Abstract

1. Perforations of the esophagus are more frequently due to trauma than intrinsic disease. Increasing use of endoscopic procedures and more frequent recognition of spontaneous or postemetic ruptures account for a marked increase in incidence of esophageal perforations in recent years. 2. The recognition of an esophageal perforation depends on an alertness to the significance of severe pain, dysphagia, fever, and elevated pulse rate, together with the presence of air or fluid in the neck, mediastinum or pleura following the ingestion of a foreign body, instrumentation of the esophagus, vigorous vomiting, trauma to the neck or chest or associated with intrinsic diseases of the esophagus. 3. The mortality of untreated perforations of the esophagus is 70 per cent or more, for those treated by drugs alone from 40 to 70 per cent, and for those treated by drainage and antimicrobial therapy 14 to 20 per cent. Prolonged morbidity at best follows conservative treatment. 4. Closure of the esophageal perforation, even late after infection of the surrounding tissues has occurred, together with drainage, antimicrobial drugs and general supportive therapy results in a low mortality, healing of the perforation and a low morbidity. 5. Advances in the treatment of esophageal perforations with a marked reduction in mortality and morbidity depend on prompt recognition and the early institution of appropriate therapy.