• Journal of Chest Surgery
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• v.19 no.4
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• pp.744-749
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• 1986

Even in the hands of the expert endoscopists, an occasional instrumental perforation of the esophagus occurs. But instrumental perforation of the esophagus should not be difficult to diagnose if the possibility is borne in mind. Occasionally patient with esophageal perforations show little reaction at first, but usually they develop systemic manifestation if surgical management is delayed. Early surgical drainage of esophageal perforation is very important & effective therapeutic method. The delayed surgical treatment of esophageal perforation would have increased the morbidity & mortality by allowing mediastinitis & empyema thoracis. We have experienced 6 cases of delayed surgical management of instrumental perforation of esophagus from May 1974 to April 1986 in the department of thoracic and cardiovascular surgery, Yonsei University, college of the medicine. The ages ranged from 4 years to 57 years. The underlying esophageal diseases consisted of esophageal stricture in 3 cases, foreign bodies in the esophagus in 2 cases and esophageal ca. in one case. Most clinical manifestations on admission were high fever, chest discomfort, chest pain, dysphagia and subcutaneous emphysema. Most complications due to esophageal rupture were acute mediastinitis with or without empyema thoracis. Failure to diagnose promptly and failure to promptly institute adequate treatment undoubtedly were largely responsible for this patients death. All 6 patients had been taken delayed surgical drainage more than 24 hours following esophageal perforation. One patient had been in the open drainage state for long time and the another patient has been in the tracheostomy with postintubation vocal cord ulceration. The third patient died due to respiratory failure and sepsis due to fulminant mediastinitis & empyema thoracis. Even if the patients with esophageal perforation have been taken delayed surgical management, the patients should be survived with aggressive & effective surgical drainage with intensive post-operative care.

• Journal of Chest Surgery
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• v.27 no.7
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• pp.598-602
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• 1994

We have experinced 20 cases of esophageal perforation from April, 1987 to August, 1993 at ourdivision of Thoracic and Cardiovascular Surgery, Korea University, Gu Ro Hospital. Here we investgates the causes of disease, symptoms and sign, locations, time lag from onset, treatment of perforation and the results.The ratio between male and female patients was 12: 8, and age ranged from 4 years to 70 years old.The cause of esophageal perforation were instrumental trauma 7 cases, stab wound 4 cases, foreign body 4 cases, spontaneous perforations 3 cases, and others 1 cases. The middle and lower portions of esophagus was frequently involved portion in our cases [11 cases of 20].The common complications after perforation were mediastinitis [6 cases] and empyema [2 cases].The method of treatment were as follows, primary repair of perforation, simple drainge techniques including simple cervical drainage and closed thoracostomy, diversion and two-staged operations during several months. There was no mortality in our cases.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1231-1235
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• 1992

Perforation of the esophagus is a rare complication of endotracheal intubation and usually occurs after hasty intubation. A 26-year-old female was transferred from other hospital for further management of empyema of the right lung. During admission, the empyema was found due to esophageal perforation, which had developed during the endotracheal intubation after acute poisoning of carbon monooxide 5 dayes prior to the transfer. The em-pyema and the esophageal perforation were successfully managed by conservative measures including effective drainage.

• Journal of Chest Surgery
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• v.23 no.1
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• pp.115-121
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• 1990

We have experienced twenty-eight patients of esophageal perforation at the department of thoracic and cardiovascular surgery, Seoul National University Hospital during the period from Jan. 1957 to Jun. 1989. The ratio between male and female patients was 17:11, and their age ranged from 2 years to 61 years old. [average: 30.4 years old] The cause of esophageal perforation were instrumental trauma in 9 cases, caustic perforation in 6 cases, spontaneous perforation in 6 cases, surgical trauma in 2 cases, and others in 5 cases. The most frequent location of perforation was in the lower third portion of the esophagus [13 case, 46 %]. Patients complained of chest pain [86 %], dyspnea [57 %], fever [57 %], subcutaneous emphysema [43 %], and others. The frequent complications of esophageal perforation were empyema [13 cases, 46 %] and mediastinitis [11 cases, 39 %]. The first treatment was supportive care in 3 cases, primary closure and reinforced procedures in 13 cases with 3 deaths, open drainage in 5 cases with 2 deaths, diversion in 4 cases with 2 deaths and closed thoracostomy drainage in 3 cases. After the first treatment, 6 patients received multi-staged operations for several months. Overall mortality was 25 %, and the most frequent cause of death was sepsis[57 %]. We thought that factors affecting the outcome of esophageal perforation are;[1] early diagnosis and adequacy in the first treatment, [2] intensive perioperative management including multi-stage surgical approach, [3] patient`s condition at the diagnosis

• Korean Journal of Bronchoesophagology
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• v.9 no.2
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• pp.44-48
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• 2003

Rupture of the esophagus is an uncommon condition that can be a formidable challenge to treat. Unless early treatment is applied, life-threatening complications, such as mediastinitis, sepsis, occurs and continue to be associated with a mortality rate of more than 20%. Definitive repair of esophageal perforation is considered the preferred treatment in the past. In the present study, conservative treatment acquired a good results by help of the development of antibiotics and nutritional supportive methods. Iatrogenic causes constituted most of the injuries, followed by external trauma, spontaneous, ingested foreign bodies, and malignancy. The incidence of perforation following ingestion of foreign bodies is very rare, so recommendations regarding treatment remain controversial. We analyzed the course of 31 patients with esophageal perforation by foreign bodies, concentrating on the diagnostic & treatment delay and methods of treatment, complications.

• Journal of Chest Surgery
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• v.12 no.1
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• pp.61-66
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• 1979

This is a report of a case of tuberculous esophageal perforation, which was surgically treated.. The patient was 32-year-old Korean female patient, who complained swallowing difficulty for` 4 weeks duration. Esophagogram was shown irregular filling defects in the upper one third of esophagus, about 4 cm in length. It was noticed that a small amount of contrast media was leaked out from the involved area of esophagus into the right mediastinum. It was highly suggested that abscess formation was due to perforation of esophageal cancer. Esophagoscopy revealed no definitive evidence of perforation of esophagus, but punch biopsy specimen of esophageal mucosa was shown acute and chronic inflammatory changes. Operation was performed under impression of esophageal cancer. In the right-sided upper mediastinum, a walnut-sized abscess cavity which was connected with esophagus through a fistulous tract was noted. A portion of cavity submitted for frozen section was shown tuberculous inflammation. The abscess cavity, fistula tract, and involved esophageal wall were removed. The perforated esophagus was closed layer by layer. The tuberculous changes were confirmed by histopathologic examination postoperatively. The postoperative course was uneventful.

• Journal of Trauma and Injury
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• v.24 no.1
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• pp.45-47
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• 2011

Esophageal perforation due to blunt trauma is rare. A 67-year-old male presented to Konyang University Hospital with painful neck swelling. His neck was injured by blunt trauma at work. Esophageal perforation was detected by neck CT and esophagography. We performed primary repair of cervical esophagus through the Lt. neck approach. The postoperative course was uneventful and the patient was discharged at postoperative day 15.

• Journal of Chest Surgery
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• v.26 no.6
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• pp.507-509
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• 1993

Esophageal perforation, regardless of the etiology, is a catastrophic event. The importances of early diagnosis and an aggressive surgical approach in the management of such a potentially lethal situation are stressed, in fact the mortality rate is directly related to the interval between perforation and initiation of treatment. We experienced a rare case of esophageal rupture caused by compressed air which produce a rupture of the colon not infrequently, which was treated successfully by an aggressive surgical approach consisting of closure of the perforation and adequate drainage.

• Journal of Chest Surgery
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• v.23 no.6
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• pp.1233-1237
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• 1990

When the perforation of intrathoracic esophagus occurs in the presence of preexisting esophageal stricture, aggressive and definitive therapy often provides the only chance for patient salvage. Two adults suffering from intrathoracic esophageal perforation with underlying stricture underwent transhiatal esophagectomy. The perforations were due to esophageal instrumentation. Restoration of alimentary continuity with a primary cervical pharyngogastric anastomosis was carried out in one patient. Another patient underwent a cervical esophagostomy and had a subsequent colonic interposition 3 months later.

• Journal of Chest Surgery
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• v.22 no.2
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• pp.342-347
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• 1989

A 4-year-old male developed the esophageal perforation after air-gun shut injury in the thorax. The esophageal perforation was found on esophagogram at the next day after the accident. Because of delayed diagnosis, mediastinitis and pyopneumothorax were developed. The general conditions of the patient were very critical with sepsis on admission. Therefore, two staged operation was planned. At the first stage, exclusion and diversion of the esophagus was carried out to treat chemical pneumonitis due to gastric contents through the esophago-bronchial fistula by gastroesophageal reflux. Clinical conditions of the patient were improved after the first stage operation. At the second stage, the esophageal reconstruction with right colon was performed.