Emergency oesophagectomy.

In the treatment of instrumental perforation of the obstructed thoracic oesophagus, relief of obstruction is one of the prerequisites of success. In some cases it is better to resect both the perforation and the original lesion rather than to rely on repair and drainage. The salient features of 19 cases of emergency oesophagectomy collected from the literature have been tabulated, and three new examples are here reported. The results are encouraging. The operation usually performed for malignant cases is a one-stage oesophagogastrectomy with oesophagogastrostomy; a two-stage procedure is recommended for benign lower-end strictures. The lacerated oesophagus and the stricture are resected at the emergency operation, and the fundus of the stomach, advanced into the chest, is anastomosed to the oesophagus. The whole of the stomach is thereby preserved for the elective reconstruction which constitutes the second stage.