Treatment
The important features are:
- prompt recognition
- nil by mouth until at least the fifth day after diagnosis; oral feeding is withheld until a contrast swallow confirms healing at this stage
- pleural space drained
- hyperalimentation with hypertonic glucose and amino acids; this allows infection to be more readily controlled and encourages wound healing
- antibiotics e.g. combination of intravenous gentamicin, cefuroxime and metronidazole
- fluid resuscitation
- surgical repair if recognised early. If there is a late presentation then surgical drainage and diversion may be needed.
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