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Eur J Cardiothorac Surg 2003;23:799-804
© 2003 Elsevier Science NL

Treatment and outcomes of oesophageal perforation in a tertiary referral centre

Department of Thoracic Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK

Received 3 September 2002; received in revised form 19 December 2002; accepted 22 January 2003.

^* Corresponding author. Tel.: +44-2890-240503; fax: +44-2890-314159
e-mail: alastair.graham{at}royalhospitals.n-i.nhs.uk

Objective: The diagnosis and management of oesophageal perforation continues to challenge clinicians. We present our experience of perforated oesophagus in a Tertiary Referral Centre for Thoracic and Oesophageal Surgery. Methods: Between 1985 and 2000, 75 patients (40 male) with oesophageal perforation were treated in out unit; age range 24–89, median 63. Retrospective review of these cases has been performed. Results: There were 12 deaths (16%). With increases in time from perforation to diagnosis, there was a stepwise increase in the mortality rate. Immediate diagnosis 5%; early diagnosis (1–24 h) 14%; late diagnosis (>24 h) 44% (P0.002). Site of perforation, aetiology, and treatment strategy had no influence on mortality. The only independent predictor of mortality identified was time to diagnosis from perforation (beta 0.429, P=0.001). Time to definitive management in those undergoing an operative procedure had no influence on outcome with multivariate analysis. Conclusions: Prompt recognition of the diagnosis of oesophageal perforation and rapid institution of supportive measures, followed by an appropriate, patient specific treatment option optimises the chance of a successful outcome. The wide range of presentation of oesophageal perforation necessitates individualisation of treatment.

Key Words: Oesophageal perforation

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