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J Thorac Cardiovasc Surg 1994;108:392-393
© 1994 Mosby, Inc.

LETTERS TO THE EDITOR

Late management of esophageal perforatio

Thoracic Surgery
Albert Einstein College of Medicine
Bronx, NY 10461

To The Editor:

I read with interest "Management of Delayed Esophageal Perforation" by Salo and others in the December 1993 issue of the JOURNAL. ¹ How should this be managed, asked the authors: "Esophagectomy or primary repair? "

To answer this question, they report their experience. Among 19 patients treated with primary repair, 13 died, which constitutes a mortality of 68.4%.The mortality for the patients in the esophagectomy group was lower, 13%, but accompanied by high morbidity because of the magnitude of the operation and long-term care necessary for esophagectomy and later reconstitution of the gastrointestinal tract. The authors recognize that the lethal factor in this group of patients is mediastinal sepsis: "Insufficient control of the mediastinal sepsis is the principal cause of death in patients with delayed esophageal perforation."

A third alternative not mentioned by the authors of this paper directs therapy directly to the treatment of mediastinitis itself. In my experience and that of others, irrigation of the mediastinum through the esophageal opening has been rewarded with complete resolution of mediastinitis. ² An extra benefit has been the spontaneous healing and closure of the esophageal opening.

If the authors had used transesophageal irrigation on their patients with a failed esophageal closure, it is possible that better results would have been obtained. I continue to recommend transesophageal irrigation in patients with mediastinitis caused by esophageal perforation as the best option for this serious condition.

References

1. Salo JA, Isolauri JO, Heikkila LJ, et al. Management of delayed esophageal perforation with mediastinal sepsis. J THORAC CARDIOVASC SURG 1993;106:1088-91.[Abstract]
   
2. Santos GH, Frater RW. Transesophageal irrigation for the treatment of mediastinitis produced by esophageal rupture. J THORAC CARDIOVASC SURG 1986;91:57-62.[Abstract]
   

This article has been cited by other articles:

				C. J. Brinster, S. Singhal, L. Lee, M. B. Marshall, L. R. Kaiser, and J. C. Kucharczuk Evolving options in the management of esophageal perforation Ann. Thorac. Surg., April 1, 2004; 77(4): 1475 - 1483. [Abstract] [Full Text] [PDF]

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Santos, G. H. Search for Related Content PubMed PubMed Citation Articles by Santos, G. H.