Abstract
A 74-year-old man developed hematemesis immediately after ingestion of a diet for a colonoscopy examination. Endoscopic examination on admission revealed deep ulceration with blood oozing immediately above the esophago-gastric junction and we stopped the bleeding with endoscopic clips and Argon Plasma Coagulation. We suspected spontaneous rupture of the esophagus based on endoscopic findings. A chest computed tomography (CT) scan showed evidence of extensive mediastinal emphysema. Consequently, we diagnosed spontaneous rupture of the esophagus. Although we stopped the bleeding eight hours after first endoscopic examination because the patient developed hematemesis again, we performed conservative treatment with intravenous hyperalimentation and antibiotics. On the 9th day of admission, a chest CT scan showed little emphysema. On the 17th day of admission, scar on the esophagus was observed endoscopically, and no leakage of radiopaque contrast agent from esophagus was observed on an esophagogram. The patient was discharged from our hospital on the 27th day of admission.
