European Journal of Cardio-Thoracic Surgery, Vol 4, 211-213, Copyright © 1990 by European Association for Cardio-thoracic Surgery
Oesophageal resection after instrumental perforation
SC Griffin, J Desai, ER Townsend and SW Fountain
Department of Thoracic Surgery, Harefield Hospital, Middlesex, UK.
Between 1981 and 1987, 11 patients underwent oesophageal resection
following endoscopic perforation of the oesophagus. They had a median age
of 67 years with a range of 36 to 88 years. They all were managed either by
one- or two-stage oesophageal resections. Six patients were perforated at
other hospitals, 5 on site. Seven had carcinoma of the middle or lower
third of the oesophagus, 2 of these were perforated at attempted palliative
intubation. Four had benign peptic strictures perforated during dilatation.
Seven were resected within the first 24 hours and 4 between 2 and 10 days
after perforation. All 4 patients with benign disease survived but 4 of the
7 patients with cancer died giving an operative mortality of 36.3%.
Respiratory complications were the most common postoperative problem: all
deaths were attributed to respiratory failure. Perforation of the thoracic
oesophagus carries a high mortality. Resection after perforation in benign
strictures may be life saving in a potentially lethal condition but
resection after perforation, even in operable cancer, still carries a high
mortality.
