DEFINITIVE SURGERY FOR SPONTANEOUS DELAYED MID ESOPHAGEAL PERFORATION MADRAS MEDICAL COLLEGE AND GOVERNMENT GENERAL HOSPITAL

Madeswaran Chinnathambi
unpublished
BackgroundEsophageal perforation, whether spontaneous or more commonly as a result of instrumentation, is a life-threatening condition and carries high mortality despite recent advances. Eso-phageal rupture may occur in all age groups, from neonates to elderly individuals , but is most frequent in middle-aged males. The esophagus lacks a se-rosal layer and the adventitia of the esophagus is contiguous with the connective tissue of the mediastinum. As a result, esophageal perforation allows the
more » ... oration allows the bacteria and digestive enzymes to enter the mediastinum and spread to the neck and the pleura A timely diagnosis typically offers more options in management, so a high index of suspicion on the part of the primary treating physician is needed. Outcome is dependent on etiol-ogy, location of injury, and interval between perforation and initiation of therapy. Successful management of esophageal perforation entails combination of (1) control of the leakage site either surgically or endoscopically to prevent further contamination, (2) drainage of contamination , and (3) appropriate antibiotics along with nutritional support Methods We report a case of Spontaneous delayed mid-esophageal perforation. The perforation was successfully managed with single stage definitive repair by gastric tube passed through posterior mediastinum which controlled the leak and removed the pathological organ.ResultsEsophageal re-section and single stage reconstruction, in a delayed spontaneous perforation with mediastinal contamination resulted in controlling of leak and treating the mediastinal contamination and ruled out the intrinsic disease Conclusions Successful management of esophageal perforation depends on early diagnosis, control of site of leak,drainage of accompanying collections, and antibiotic and nutritional support. More accurate diagnosis and Aggressive Operative therapy is required in patients with large uncontained perforations and extensive contamination to reduce morbidity and mortality .
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