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August 1965

Conservative Management of Esophageal Perforation

Author Affiliations

From the Division of Thoracic Surgery, Ohio State University.

Arch Surg. 1965;91(2):238-240. doi:10.1001/archsurg.1965.01320140028006

Introduction  SINCE the impetus given endoscopy by Chevalier Jackson in the early years of this century, esophagoscopy has remained a valuable adjunct to the diagnosis and treatment of esophageal disease. Perforation of this thin-walled organ has, however, remained a constant source of worry to the endoscopist. Until 1940, perforation of the esophagus was accompanied by an appalling mortality rate. Subsequently it became recognized that early surgical intervention with closure of the perforation dramatically reduced this mortality rate. The present study gives our experience with nonoperative treatment of esophageal perforation resulting from endoscopy and highlights the impact of antibiotics on this dread complication.In 1948, Jemerin,1 in analyzing esophageal perforations of diverse etiologies, reported a mortality rate of 69% in patients treated non-operatively. He was able to reduce this mortality rate dramatically with the introduction of early drainage of the mediastinum and closure of the perforation, or both. Most large

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