TECHNICAL NOTES   

Chirurgia 2009 October;22(5):247-8

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Surgical repair of esophageal rupture: how to do it

Baikoussis N. G., Beis J. P., Siminelakis S. N.

Cardiothoracic Surgery Department, University Hospital of Ioannina, Ioannina, Greece

Surgical approach is the treatment of choice for patients with esophageal rupture, once the diagnosis has been established. Iatrogenic injury is the most common cause of perforation. Acute chest or abdominal pain, odynophagia and dyspnoea are common symptoms. Pleural effusion, pneumothorax and pneumomediastinum are nonspecific chest X-ray findings. An alternative surgical technique for reconstruction of esophageal rupture and perforation is here described. Pre-aortic peritonea is used to reinforce the injured site. The modified technique was utilized in one patient undergoing surgery because of esophageal rupture and perforation after dilatation due to esophageal achalasia. Perforation of the esophagus results in a chemical and infectious mediastinitis, which is lethal unless treated early and effectively. The site of closure should always be reinforced with healthy vascularized tissues, most commonly thickened parietal pleura, pedicled intercostal musculopleural flap, pericardial fat, strip of pedicled diaphragm, or omentum and gastric fundus. Performing a left thoracotomy, every infected and necrotic tissue was drainage, and then esophageal repair was performed. Once the site of perforation was found, the diameter and the lips of the injury were examined in details. The careful suture of the mucosa is considered important but not enough. In this small series authors use a portion of pedicled pre-aortic peritonea to reinforce the esophageal wall.