Operations for Esophageal Perforations and Anastomotic Leaks

  • Jameson L. Chassin


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.


Anastomotic Leak Nonoperative Management Esophageal Perforation Thoracic Esophagus Suture Repair 
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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

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