Spontaneous esophageal perforation

ABSTRACT

Despite new effective antibiotics, improved caloric intake, better monitoring and life support systems in general as well as many advancements made in thoracic surgery, the management of patients with spontaneous esophageal perforation remains one of the major therapeutic challenges for surgeon and also remains controversial one. We are reporting two cases of spontaneous esophageal perforation with delayed diagnosis. One patient with 10 days history was subjected to conservative management with nasogastric aspiration, antibiotics, tube thoracotomy and feeding jejunostomy. When conservative measures failed with development of sepsis, surgical intervention was performed with an unsuccessful outcome. Another patient presented 16 hours after sudden onset of chest pain and diagnosed to have spontaneous esophageal perforation with esophago-pleural fistula. He was operated within 24 hours with primary repair buttressed with pedicled omental patch. He developed leakage and managed subsequently with asophagectomy with favourable outcome. We conclude that spontaneous esophageal perforation carries a high mortality and delay between rupture and treatment is the major factor affecting outcome: