Clinical challenge : An experience of spontaneous transmural rupture of the oesophagus in Taiwan

: In Taiwan, spontaneous oesophageal rupture is uncommon but the outcome is often lethal because of failure to make an early diagnosis. We have analysed clinical data, management and the risk factors that affect mortality for a consecutive series of 11 patients who had spontaneous oesophageal perforation between 1983 and 1994. The primary symptom was chest or abdominal pain, which was present in 100% of patients; 91% of patients had abnormal chest x-ray (63% pleural effusion, 46% pneumomediastinum, 37% subcutaneous emphysema). In our series of patients the lower thoracic area was the most common location of the perforation (80% of patients. There were no statistically significant differences in mortality due to age, underlying disease, perforation size, location or surgical methods. A poor prognosis seems to be correlated with the time elapsed between the perforation and treatment (especially if > 72 hours) (p < 0.05), respiratory failure (p < 0.05), and heavy contamination of the mediastinum (p < 0.05). The clinical findings depend on the location and time of perforation. History, chest x-ray and oesophagogram are the most useful diagnostic tools. Early diagnosis and treatment are mandatory for these patients.