Objectives: (1) To determine the actual incidence of transmural pharyngeal and oesophageal injuries (POI); (2) to reveal the main causes and character of infectious complications following transmural POI; (3) to evaluate the effectiveness of different types of urgent surgical intervention for complicated transmural POI.
Methods: A detailed retrospective analysis was completed on 15 years (1987-2001) of clinical experience, involving 84 cases of POI, caused by neck or chest injuries, foreign bodies, tracheal intubation, oesophagogastroscopy and oesophageal dilation (bougienage).
Results: Transmural (perforating) and superficial (non-perforating) POI were revealed in 58 and 26 cases, respectively. Transmural POI was diagnosed within 24h in 38 of the 58 patients. Fourteen patients with uncomplicated transmural POI were treated conservatively; all recovered uneventfully. Forty-two patients with complicated transmural POI underwent urgent surgical intervention. Hospital stay was shorter in patients who underwent primary repair of the perforated pharyngeal or oesophageal wall than in those who had only irrigational drainage ( 22.4 +/- 5.3 days versus 31.7 +/- 8.4 days). Overall post-operative morbidity and mortality were 42.8 and 19.0%, respectively.
Conclusions: (1) Transmural injuries occurred in approximately two-third of the total number of POI; (2) underlying pathology, location of injury, time to accurate diagnosis and, eventually, urgent surgical intervention constituted statistically significant influences ( P < 0.05) relevant to development of complications following transmural POI; (3) urgent surgical intervention is the main part of the combined treatment of complicated transmural POI.