Improved Operation for Esophageal Rupture

Abstract

THE HAZARDS of spontaneous perforation of the esophagus are such that 16 years after the first successful primary closure,¹the mortality rate varies between 34% and 50%.²In addition, the morbidity is considerable, and, while mediastinal drainage is readily accomplished and often life-saving, primary closure of the inflamed esophageal wall is commonly followed by suture-line breakdown and empyema. Recently Tuttle and Barrett,³reporting on four patients with spontaneous perforation of the distal esophagus, all of whom experienced sutureline breakdown when primary closure was attempted. The term Mallory-Weiss syndrome has been used to embrace both mucosal ulceration of the gastroesophageal junction with hemorrhage, and spontaneous perforation of the esophagus. It is true that both probably represent variants of the same disease. However, the former lesion was originally described by Mallory and Weiss, and the latter was described in the 18th century by Boerhaave. Moreover, complete perforation requires urgent