Delayed Primary Repair of Esophageal Rupture.
- Author:
Kil Dong KIM
1
;
Kyung Young CHUNG
;
Chang Suh KIM
;
Han Gy PARK
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Yonsei University, College of Medicine, Korea.
- Publication Type:Original Article
- Keywords:
esophageal perforation
- MeSH:
Cause of Death;
Debridement;
Drainage;
Esophageal Perforation;
Esophagus;
Foreign Bodies;
Hemorrhage;
Humans;
Mortality;
Mucous Membrane;
Pleura;
Rupture*;
Stomach Ulcer
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
1998;31(1):46-51
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Treatment of esophageal perforation when diagnosed late remains controversial. Ten consecutive patients since 1990 were treated late (later than 24 hours) for esophageal perforation with primary repair. Four perforations were iatrogenic, 3 were spontaneous, 2 were foreign body aspiraton and 1 was trauma. The interval from perforation to operation was 116 hours in mean and 48 hours in median value. The principles of repair included (1) a local esophagomyotomy proximal and distal to the tear to expose the mucosal defect and intact mucosa beyond, (2) debridement of the mucosal defect and closure, (3) reapproximation of the muscle, and (4) adequate drainage. The repair was buttressed with parietal pleura or pericardial fat in 9 patients. Associated distal obstruction was treated with dilation and esophagomyotomy intraoperatively. There was one mortality and cause of death was massive gastric bleeding due to gastric ulcer on 33rd day after operation. Five patients had leak at the site of repair and these cases were treated completely with conservative treatment except a mortality case. In conclusion, in the absence of malignant or irreversible distal obstruction, meticulous repair of perforated esophagus and adequate drainage are preferred approach, regardless of the duration from the injury to the operation.
