Abstract
While instrumental perforations of the esophagus are usually amenable to early diagnosis and treatment, noninstrumental perforations occur under such heterogeneous circumstances that late recognition and treatment often leads to a high morbidity and mortality. In this study, noninstrumental perforations of the esophagus resulted in a 30 percent mortality. Postemetic perforations proved to be particularly lethal, especially when definitive treatment was delayed more than 24 hours and when complicating esophageal disease was present. Perforations due to the ingestion of a sharp foreign body responded well to treatment even when seen late after perforation. A group of esophageal perforations that occurred late after operations on structures adjacent to the esophagus were thought to be due to periesophageal infection. The rupture developed with spontaneous drainage into the esophagus. Because of the chronic nature of these postoperative perforations, delayed treatment was well tolerated.
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