10 adult patients with spontaneous or iatrogenic esophageal perforations with delayed recognition have been treated at our institutions and form the basis for this report. The diagnosis of perforation of the esophagus in our group of patients was delayed 36-96 hours from the time of presumed perforation. All patients were treated surgically using a modification of the Abbott technique. Thoracotomy was performed with copious irrigation and debridement of dead tissue and biopsy; an esophageal 36F silastic T tube was placed through the perforation with appropriate safe positioning. Our procedure also included routine thoracostomy tube chest drainage, placement of decompressive gastrostomy and feeding jejunostomy, endotracheal intubation or tracheostomy for positive pressure breathing; and appropriate antibiotics and intensive care unit type of aggressive supportive therapy. In our group of 10 patients, there are eight long term survivors of one to five years with excellent results. Their T tubes were removed within three to four weeks. The fistulas healed spontaneously in all eight patients without strictures as confirmed by follow up roentgenographic contrast studies and/or fibroptic endoscopy. All of them became asymptomatic. There were two deaths.
|Original language||English (US)|
|Number of pages||4|
|State||Published - Dec 1 1976|
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