The diagnosis and management of perforations of esophagus and pharynx sustained during intubation of neoplastic esophageal strictures.

Twenty-six esophageal and eight pharyngeal perforations sustained during palliative intubation of esophagogastric neoplasms have been reviewed. The majority of the tears were recognized either endoscopically or by the immediate development of subcutaneous emphysema. However, 15 perforations were first identified by radiology, and 10 of these 15 patients were initially asymptomatic. In the years 1976-1979 with conservative management, three patients of eight died from the perforation and none had a pneumothorax. From 1980 a more aggressive nonsurgical approach was used, and of 26 patients who sustained a perforation, there were six deaths before leaving hospital but only four deaths were directly related to the perforation and each of these had sustained a pneumothorax. Pharyngeal tears invariably did well with conservative management. Our experience favors conservative management for instrumental esophageal perforation.