Onat et al. Journal of Cardiothoracic Surgery 2010, 5:46 http://www.cardiothoracicsurgery.org/content/5/1/46 Open Access RESEARCH ARTICLE BioMed Central © 2010 Onat et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Research article Factors affecting the outcome of surgically treated non-iatrogenic traumatic cervical esophageal perforation: 28 years experience at a single center Serdar Onat* 1 , Refik Ulku 1 , Kemal M Cigdem 2 , Alper Avci 1 and Cemal Ozcelik 3 Abstract Background: We reviewed our experience with non-iatrogenic traumatic cervical esophageal perforations, paying particular attention to factors affecting the outcome of such cases. Methods: In total, 30 patients treated surgically between 1980 and 2008 for non-iatrogenic traumatic cervical esophageal perforation in our clinic were reviewed. Results: There were 25 male and 5 female patients with a median age of 27.5 years. The type of injury was external trauma in 21 (70%) patients and endoluminal injury in the remaining 9 (30%) patients. The mechanism of injury was gunshot in 16 patients, stabbing in 4, falling in 1 (extraluminal injury), and foreign body in 9 (endoluminal injuries). The overall mortality rate was 16.6% (5/30). The mortality rate for extraluminal injuries was 19%, and for endoluminal injuries was 11.1%. Mortality in patients treated within 24 h of sustaining injury was substantially less than in those for whom diagnosis and treatment were delayed (12.5 and 21.4%, respectively). The mortality rate was 33.3% (3/9) for patients with tracheal injuries and 9.5% (2/21) for those without tracheal injuries. Conclusions: A treatment delay greater than 24 h, the presence of tracheal injury, or extraluminal perforation significantly affected the outcome of surgically treated non iatrogenic traumatic cervical esophageal perforation. Introduction Perforation of the esophagus is a life-threatening condi- tion. This is because the esophagus lacks a serosa and is surrounded by a loose areolar connective tissue, which is unable to prevent the spread of infection and inflamma- tion [1]. Traumatic injuries to the esophagus encompass a heterogeneous group of injuries that may be iatrogenic or non iatrogenic. The cause of injury is ingested foreign body in 12% and trauma in 9% of patients, while iatro- genic injury remains the most frequent cause of esopha- geal perforation (59%) [2]. Non-iatrogenic traumatic cervical esophageal perforation is a difficult clinical entity, and management requires a thoughtful and indi- vidualized approach. The low incidence of this particular problem leads to little clinical experience in surgeons. Thus, we reviewed our experience with non-iatrogenic traumatic esophageal perforation, paying particular attention to factors affecting morbidity and mortality in these patients. Methods The medical records of 30 cervical esophageal perfora- tions due to non-iatrogenic trauma treated surgically in our hospital between 1980 and 2008 were reviewed. Patients in whom instrumentation was clearly and directly responsible for the perforation (even in the pres- ence of a foreign body), patients who died within 24 h due to non-esophageal related complications, patients who suffered from thoracic or intra-abdominal esophageal injury, and patients treated non-operatively for cervical esophageal perforation were excluded. Patients with cer- vical esophageal perforations due to foreign bodies or with external trauma treated surgically were included. Demography, clinical presentation, diagnostic investi- gations, mechanism of injury, associated injuries, time interval between admission and definitive surgical care, management, hospital stay, and morbidity and mortality * Correspondence: onatserdar21@hotmail.com 1 Department of Thoracic Surgery, Faculty of Medicine Dicle University, Diyarbakir, Turkey Full list of author information is available at the end of the article