Les perforations par traumatisme interne de l’oesophage

Abstract

Introduction: Esophagus traumatic perforations still carries high morbidity and mortality rates. There is no consensus regarding the appropriate management of this life-threatening condition. The aim of this study is to analyse treatment of traumatic esophageal perforations.
Patients and methods: This retrospective study was made with seven patients treated for traumatic perforation of the esoephagus at the ENT department of the Habib Bourguiba Hospital. All patients were men. The mean age was 24 years. One patient has a history of an idiopathic megaesophagus and another have a history of a caustic stenosis.
The traumatism was by foreign body in 2 cases, at the time of an  extraction of foreign body in 3 cases and at the time of
a traumatic endoscopy in 2 cases.
Results: The treatment consisted on an isolated medical treatment in 1 case and associated to the surgery for the 6 other patients. The surgical treatment was conservative in 2 cases. Esophagus exclusion with replacement was made in 4 cases. After treatment, evolution was good for all patients.
Conclusion: Esophageal perforations can cause death by some serious complications. The treatment is a medico-surgical urgency. The medical treatment must be founded in all the cases as of the suspicion of the diagnosis. The surgery is indicated for complications or during the monitoring in the absence of improvement under medical treatment. The majority of the authors choose conservative treatment especially if the diagnosis is made in the 48 first hours. The radical surgery is kept for the failures of the conservative treatment.
Key words: Perforation, esophagus, foreign body, endoscopy, surgery, prognosis.