No abstract

The presentation, diagnosis and management of 14 cases of spontaneous transmural oesophageal rupture have been reviewed. Analysis suggested that the classical triad of vomiting, chest pain and subcutaneous emphysema was rare (1/14) and therefore misleading. Abdominal pain and tenderness obscured the clinical picture; the temporal relationship of pain to vomiting varied and subcutaneous emphysema was uncommon (4/14). Consequently, only two cases were correctly diagnosed on presentation and diagnosis in the others was markedly delayed (average 4 days). Contrast swallow examination, when eventually performed, was diagnostic. Twelve patients underwent repair: four under 24 h, who all survived and eight over 24 h, amongst whom there were one (12.5 per cent) operative and two (25 per cent) late deaths. Conservative management was successful in the remaining two cases. Oesophageal fistula, empyema and incorrect initial surgery were common and serious complications. Management options are reviewed and their relative merits considered.

It is suggested that these lesions should be classified into three main categories based on embryology-bronchogenic cyst (resulting from a defect of lung budding), intramural oesophageal cyst (true duplication), and enteric cyst (resulting from the split notochord syndrome). A series of 41 patients is reported. Seven of our patients suffered complications, and in two cases these nearly resulted in the death of the patient. These complications are described and their serious import is used to emphasize the desirability of surgical removal of all these foregut derivatives before complications ensue.Cystic intrathoracic lesions of foregut origin are now well recognized and account for approximately 10% of lesions presenting as mediastinal tumours (Morrison, 1958). The terminology used to describe mediastinal endodermal cysts has been confused and sometimes ambiguous. The embryological derivation of these lesions has been the cause of much speculation. The purpose of this paper is to report a series of 41 intrathoracic foregut cysts, to show that they fall into three distinct categories on the basis of embryology, to emphasize the occurrence of serious complications, and, for this reason, to urge surgical removal of the lesions.

. (1978). Thorax, 33,[359][360][361][362][363][364][365][366][367]