Diagnosi e trattamento delle perforazioni e rotture esofagee

In this study the clinical behaviour of 11 patients with esophageal perforation is reported. The lesion was iatrogenic in 7 cases occurring in the course of esophagoscopy, caused by foreign body ingestion in 3 cases and spontaneous in one case (Boerhaave). All patients were symptomatic at the time of diagnosis and pain was the most common disturbance. Serious complications occurred in all (4/11 cases) patients diagnosed after 48 hours, while only in one of the seven diagnosed within 24 hours. The treatment, except for special cases, has to be surgical by suturing directly the lesion. Fundoplication, if the lesion involves the abdominal esophagus, or gastrostomy seem to be useful if associated to the primary suture or to the pleuromediastinic drainage. Esophageal resection should be kept for cases in which either a malignant lesion or a nonmalignant stenosis refractory to endoscopic dilatations is present. The mortality rate in our study was 18% (2/11 patients).