Operations for Esophageal Perforations and Anastomotic Leaks

  • Jameson L. Chassin

Abstract

Although several retrospective studies of esophageal perforations have identified groups of patients who survived with conservative therapy, it must be emphasized that these patients must be carefully selected. When a patient sustains a small perforation of the cervical esophagus following elective esophagoscopy and has minimal symptoms, both local and systemic, nonoperative management by means of antibiotics and intravenous feeding may prove successful. On the other hand, a spontaneous perforation of the thoracic esophagus following a bout of retching in a gourmand with a full stomach should always be treated by prompt operation. Otherwise, a fulminating necrotizing mediastinitis will develop because the chest has been flooded by the powerful digestive ferments of the stomach and duodenum. Nonoperative management is acceptable only in patients who have experienced a contained leak with minimal symptoms and no sign of systemic sepsis. In the thoracic esophagus the presence of fluid or air in the pleural cavity is a contraindication to conservative treatment.

Keywords

Anastomotic Leak Nonoperative Management Esophageal Perforation Thoracic Esophagus Suture Repair 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Abbott OA, Mansour KA, Logan WD Jr et al. (1970) Atraumatic so-called “spontaneous” rupture of the esophagus: a review of 47 personal cases with comments on a new method of surgical therapy. J Thorac Cardiovasc Surg 59: 67PubMedGoogle Scholar
  2. Cameron JL, Keiffer RF, Hendrix TR, Mehigan DG et al. (1979) Selective nonoperative management of contained intrathoracic esophageal disruptions. Ann Thorac Surg 27: 404PubMedCrossRefGoogle Scholar
  3. Goldstein LA, Thompson WR (1982) Esophageal perforations: a 15 year experience. Am J Surg 143: 495PubMedCrossRefGoogle Scholar
  4. Grillo HC, Wilkins EW Jr (1975) Esophageal repair following late diagnosis of intrathoracic perforation. Ann Thorac Surg 20: 387PubMedCrossRefGoogle Scholar
  5. McKinnon WMP, Ochsner JL (1974) Immediate closure and Heller procedure after Mosher bag rupture of the esophagus. Am J Surg 127: 115PubMedCrossRefGoogle Scholar
  6. Michel L, Grillo HG, Malt RA (1981) Operative and nonoperative management of esophageal perforations. Ann Surg 194: 57PubMedCrossRefGoogle Scholar
  7. Sarr MG, Pemberton JH, Payne WS (1982) Management of instrumental perforations of the esophagus. J Thorac Cardiovasc Surg 84: 211PubMedGoogle Scholar
  8. Skinner DB, Little AG, DeMeester TR (1980) Management of esophageal perforation. Am J Surg 139: 760PubMedCrossRefGoogle Scholar
  9. Thal AP, Hatafuku T (1964) Improved operation for esophageal rupture. JAMA 188: 826PubMedCrossRefGoogle Scholar
  10. Triggiani E, Belsey R (1977) Oesophageal trauma: incidence, diagnosis, and management. Thorax 32: 241PubMedCrossRefGoogle Scholar
  11. Urschel HC Jr, Razzuk MA, Wood RE, Gailbraith N et al. (1974) Improved management of esophageal perforation: exclusion and diversion in continuity. Ann Surg 179: 587PubMedCrossRefGoogle Scholar
  12. Wilson SE, Stone R, Scully M, Ozeran L et al. (1982) Modern management of anastomotic leak after esophagogastrectomy. Am J Surg 144: 94CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1984

Authors and Affiliations

  • Jameson L. Chassin
    • 1
    • 2
    • 3
    • 4
    • 5
  1. 1.New York University School of MedicineUSA
  2. 2.Booth Memorial Medical CenterFlushingUSA
  3. 3.University Hospital, New York University Medical CenterUSA
  4. 4.New York Veterans Administration HospitalUSA
  5. 5.Bellevue HospitalUSA

Personalised recommendations