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April 1992

Esophageal Perforation: A Reassessment of the Criteria for Choosing Medical or Surgical Therapy

Author Affiliations

Mayo Medical School Section of General Thoracic Surgery Mayo Clinic and Mayo Foundation Rochester, MN 55905

Arch Intern Med. 1992;152(4):693. doi:10.1001/archinte.1992.00400160011002

The treatment of esophageal perforation remains controversial. A perforation of the esophagus can present in different locations, have different causes, and present following different durations of time. Because of these variables and the grave prognosis if handled improperly, treatment requires experienced judgment by both medical and surfgical personnel. The goals include adequate drainage of contaminated spaces and prevention of further contamination,1 ultimately resulting in a live patient with normal alimentation. How this is accomplished should be determined by the presentation and course of the patient. Many patients will need urgent surgical intervention. To this end, early evaluation by a surgeon is needed in patients with an esophageal perforation.

Shaffer and colleagues2 reviewed 25 patients who were treated for esophageal perforation over a 9-year period at the University of Virginia. Twelve patients were managed surgically, and 13 patients were treated without surgical intervention. Shaffer et al are to be