Perforation of the oesophagus. A comparison between surgical and conservative treatment.

A series of 48 patients with oesophageal perforations was reviewed retrospectively. Eighty-seven per cent of the perforations were iatrogenic. Twenty-four patients were treated conservatively; 3 of this group died. The other 24 patients were treated surgically and 4 of them died. Patients with alarming symptoms and/or a large perforation underwent operative treatment unless there were contra-indications. Retained foreign bodies after perforation, and malignancy in the perforation area, were considered as indications for operation. Conservative treatment was reserved for patients with minor tears combined with a less turbulent course. The interval between perforation and therapy was not of decisive importance for the mortality in our series. The clinical picture, which was dominated by chest pain, gave the earliest indication of perforation, while the responses of the sedimentation rate, temperature and white blood count occurred later and were less reliable diagnostic signs.