Esophageal resection and immediate reconstruction in esophageal perforations.

BACKGROUND

Esophageal perforation is a disease with high mortality. Treatment is controversial and should be individualized. Elapsed time, location and perforation all play a role in determining the treatment option: from conservative treatment to esophagectomy. We undertook this study to report on primary esophagectomy and reconstruction in esophageal perforations with expert surgeons and selected patients. It is worth noting the rare complication of perforated peptic ulcer on Barrett's esophagus presented in one of our patients.

CLINICAL CASES

We report two patients with esophageal perforation (one spontaneous and another due to pneumatic esophageal dilation) treated by primary esophagectomy and reconstruction. The patient with spontaneous perforation had Barrett's esophagus with severe dysplasia and perforated peptic ulcer.

CONCLUSIONS

Esophageal resection and immediate reconstruction is controversial. It was decided to resect the esophagus in both cases reported here due to the size of the perforation and esophageal disease in the second case. The primary reason for immediate reconstruction in selected cases is permanent resolution. Primary cervical esophagealgastric anastomosis has a lower risk of contamination and leaks than thoracic anastomosis, resulting in mediastinal drainage and parenteral nutrition. Spontaneous esophageal perforation due to perforated Barrett's ulcer is uncommon. Finally, we must consider the importance of early diagnosis and treatment. It is essential to consider the size of the perforation, location, previous esophageal disease, age and general status of the patient in order to undertake appropriate management. Emergency surgery should be individualized and depends on surgeon's experience.