Early diagnosis saves lives in esophageal perforations

Abstract

Aim: Esophageal perforations are rare but highly fatal pathologies. This study aims to discuss the treatment methods for esophageal perforations. Materials and methods: Twenty-two patients who were diagnosed with esophageal perforation in the Ondokuz Mayis University Faculty of Medicine's thoracic surgery clinics between 2000 and 2011 were retrospectively evaluated. Results: The cause of perforation was foreign body in 17 patients, dilatation with bougie in 2, balloon dilatation in 2, and spontaneous rupture in 1. Eight patients had cervical, 12 had thoracal, and 2 had thoracoabdominal esophagus perforations. The period between perforation occurrence and treatment was longer than 24 h in 10 patients and shorter than 24 h in 12 patients. Eight patients were treated with primary repair and debridement, 5 with chest tube drainage and conservative treatment, and 1 with self-opening stent, and 1 patient underwent resection. On the other hand, 7 patients were followed with conservative therapy after the removal of the foreign body with esophagoscopy. There was 1 mortality in the surgically treated group, while there were 4 in the conservatively treated group. Conclusion: Surgery is the "gold standard" for the treatment of esophageal perforations. Conservative therapy should be applied only in selected patients under careful monitoring. The most important factor for morbidity and mortality is early diagnosis and determination of the treatment method that best suits the patient.