Infections due to esophageal perforation are obviously life-threatening. My approach to these problems is certainly influenced much less by time than the authors present in their algorithm. In fact, I really do not think that the time of perforation should enter into treatment decisions to any significant extent. In our tertiary referral center, we often have patients transferred to our institution many days after perforation. Generally, we try to treat the patients in a similar fashion regardless of the time that they are seen after esophageal perforation.
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