Pressure rupture and spontaneous perforation of the oesophagus

Thirty-nine cases of traumatic perforation of the oesophagus or stomach have been studied. Thirty-two of the perforations followed oesphagoscopy, five were 'spontaneous,' and two were due to damage by a foreign body. Eight of the perforations occurred in the cervical oesophagus, 22 in the thoracic portion, and nine were in either the abdominal oesophagus or the stomach. Treatment was of two types-either operative closure of the perforation or a conservative routine of intravenous fluids, parenteral antibiotics, and cessation of oral feeding. In some patients treated conservatively, drainage procedures were also carried out. Five patients with terminal carcinoma, in whom oesophageal intubation after prolonged dysphagia caused perforation, had no treatment apart from analgesics and sedatives. Several of the patients treated by surgical closure had a concurrent definitive operation (resection of carcinoma in four cases and myotomy for achalasia in two cases). Fourteen of the 21 patients treated by repair or resection of the perforation survived. Ten of the 13 treated conservatively also survived. The good results of conservative treatment for cervical perforations appear to make it the treatment of choice. Only an occasional case of thoracic perforation is suitable for conservative treatment, and as a general rule perforations in this area and in the peritoneal cavity should be treated surgically.Traumatic perforation of the oesophagus or stomach is usually caused by instrumentation, foreign body trauma, or so-called spontaneous rupture. Of these, perforation during oesophagoscopy is the most common. The rigid metal oesophagoscope and the instruments used for oesophageal dilatation are the principal causes of damage. The relatively recent fibre-optic endo-

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“…Clark and Tankel (1964) recorded the case of a patient who was sleeping at the time of onset. It may follow a blow on the stomach (Nelson, 1959).…”

Section: Overall Mortality Resulting From Perforationmentioning

confidence: 99%

Traumatic rupture of the oesophagus and stomach

Craddock¹,

Logan²,

Mayell³

1968

Thorax

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“…We would retain the term 'spontaneous' for such cases as true perforation of peptic ulcer of the oesophagus, as suggested by Clark and Tankel (1964). This distinction between the two types of lesion was also made by Mackler (1952).…”

Section: Case Reportmentioning

confidence: 89%

Spontaneous rupture of the oesophagus: Endoscopic treatment in the primary stage

Härmä

Koskinen

Suurkari

1968

Thorax

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A case of spontaneous rupture of the oesophagus occurring in the right wall of the midoesophagus is reported. The treatment, conservative in the primary stage of the disease, is described. This consisted of per-oesophageal drainage of the mediastinum, effected endoscopically. In spite of complications-an empyema in the right pleura and an oesophagocutaneous fistula-the treatment was successful, resulting in a complete cure about two years after the accident. The patient has remained in good health since then.

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“…Most cases of spontaneous rupture occurred following forceful vomiting and particularly after attempts had been made to suppress this desire by contraction of the cricopharyngeus, thus converting the flaccid oesophagus into a high-pressure chamber (Moynihan, 1954). Post-emetic dehiscence, which includes all the cases described in the present study, has been renamed 'primary pressure rupture' and the term 'spontaneous rupture' is reserved for those occurring at rest or during sleep (Heroy, 1952;Clark and Tankel, 1964). 'Secondary pressure rupture' might be an apt description of those cases occurring after epilepsy (Klein and Grossman, 1943), asthma (Raffle, 1993, and parturition (Kennard, 1950).…”

Section: Discussionmentioning

confidence: 99%

Spontaneous rupture of the oesophagus. Avoidance of postoperative morbidity

Keighley

Girdwood

Ionescu

et al. 1972

Journal of British Surgery

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SUMMARYTwelve cases of 'spontaneous rupture' of the oesophagus occurring over a period of 20 years (195 1-71) are reviewed. The principal clinical and radiological features are described and the factors concerned in the pathogenesis of this condition are discussed. Although the mortality rate in this study was low (8 per cent) the incidence of severe postoperative complications was considerable, occurring in 10 of the 11 operative survivors. The importance of early diagnosis and adequate surgical treatment in the avoidance of this high morbidity is stressed.

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Pressure rupture and spontaneous perforation of the oesophagus

Cited by 11 publications

References 6 publications

Traumatic rupture of the oesophagus and stomach

Traumatic rupture of the oesophagus and stomach

Spontaneous rupture of the oesophagus: Endoscopic treatment in the primary stage

Spontaneous rupture of the oesophagus. Avoidance of postoperative morbidity

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