Management of instrumental perforations of the esophagus occurring during treatment of corrosive strictures

Abstract Background: The initial symptoms of esophageal perforations (EP) may be subtle, but the progression is very rapid, and the outcome may be disastrous unless the diagnosis is made early and proper treatment is started immediately. Methods: Between 1976 and 1996, 1,249 patients with caustic esophageal burns were treated at Ege University. The study group is composed of 52 patients with instrumental EP. Perforations occured during dilatation attempts of esophageal strictures. Twelve patients were referred from other institutions after the occurrence of EP. Results: In two patients, emergency surgical repair of the perforation was possible. Seventeen patients with unilateral and two patients with bilateral empyema were treated by pleural drainages. Anterior retrosternal mediastinal drainage was needed in one patient, and 11 patients required posterior mediastinal drainages. Three patients were treated by both anterior and posterior mediastinal drainage. Tracheoesophageal fistulas (TEF) developed in eight patients immediately after a dilatation attempt. Seven of these patients required esophageal replacement with colon to bypass the fistulas, and one patient in this group healed spontaneously. EP healed in 42.5 ± 49.4 days. Twelve (23%) patients died of mediastinitis and sepsis. Conclusion: When EP is diagnosed and treated with these methods, the mortality rate should approach zero.