Canadian Journal of Anesthesia, Vol 15, 276-280, Copyright © 1968 by Canadian Anesthesiologists' Society

Role de L'Anesthesiste-Reanimateur Dans Les Cas de Rupture Spontanee de L'Cesophage

¹ Département d'anesthésiologie, Hôpital central de Rovaniemi (Lapin keskussairaalan), Finland

In the treatment of spontaneous rupture of the oesophagus, we believe that the correction of acidosis, Pco₂ and electrolyte imbalance, infection, and shock has great importance before any immediate operation is decided upon. There is no doubt that early diagnosis of the rupture influences the surgical treatment, prognosis, and recuperation of the patient. In the case reported herein, the rupture was diagnosed rather late. The presence of acidosis, electrolyte disturbances, infection, and shock, and the frequent opening of the sutures when the operation is performed 24 hours after the rupture, have taught us to treat the patient conservatively.

The patient described herein was placed under continuous antibiotics. Cortisone, pleural drainage and oral hygiene were administered, a nasogastric tube was inserted, and feeding was mainly through the gastrostomy tube. Neuroleptanaesthesia (thalamonal) seems to be the method of choice in these cases. The patient was under periodic Astrup control, and laboratory tests and X-rays were taken in order to follow the process. During his one-month hospitalization in Oulu, his general state was satisfactory. The loss of weight was minimal. At present (less than a year later), the oesophageal fistula has already closed. Only the problem of empyeme still persists. We would hope that with medical treatment it will be resolved in due time. However, we believe that four months should be the limit of conservative treatment, and beyond that, surgical treatment of the oesophagus should be considered.