To the Editor:—
The undue emphasis placed on the "Conservative Management of Esophageal Perforation" following endoscopy (JAMA 193:537, 1965) is seriously questioned.From our experience, based on knowledge and management of 24 cases and supported by the reports of a large number of endoscopists and thoracic surgeons, we feel strongly that:
We must not give the impression to general practitioners and other medical specialists that a ruptured esophagus, like a ruptured appendix, must generally be treated
Early closure or attempted closure of a ruptured esophagus with adequate surgical drainage will result in decidedly lower morbidity and mortality rates. The dangers inherent in closed-space infection, particularly of the mediastinum, are too great.
Instrumental perforation of the pyriform sinus and cervical esophagus should have immediate cervical mediastinotomy.
Intrathorax esophageal tears and ruptures should be treated by thoracotomy with esophageal repair if possible, and with adequate mediastinal and pleural drainage.