Perforation of the thoracic esophagus can be fatal unless diagnosed promptly and treated effectively. The high mortality with
delayed treatment is due principally to an inability to effectively close the perforation and prevent leakage. From 1982 to 1988, 7 consecutive patients (aged 16 to 73 years) were treated after a delayed diagnosis (26 hours to 25 days) of thoracic
esophageal perforation. In all patients, the perforation was closed after
debridement with total exclusion of the esophagus (T-tube
cervical esophagostomy plus absorbable
ligatures applied to the esophagogastric junction and the cervical esophagus distal to the
esophagostomy). Radical decortication and wide mediastinal and pleural drainage were also done. Nutritional supply was given through a feeding
gastrostomy.
Antibiotics were administered according to the results of cultures. All patients survived. Continuity of the esophagus was established by removal of the T tube and spontaneous absorption of the
ligatures. Endoscopy and esophagography performed 4 weeks after the initial operation showed a well-healed esophagus without
stenosis or leakage in all patients. No secondary
thoracotomy or esophageal reconstruction was necessary. No
dysphagia was noted during follow-up (range, 12 to 50 months; mean follow-up, 23 months). We conclude that primary closure of the perforation and total esophageal exclusion with the use of absorbable
ligatures and T-tube
esophagostomy can provide a one-stage operation with good results for repair of thoracic
esophageal perforation diagnosed late.