2020 Volume 40 Issue 5 Pages 689-692
A 54–year–old man who was diagnosed as having advanced squamous cell carcinoma of the esophagus in June 2017 received treatment at our institution. While he showed complete response after chemotherapy and chemoradiotherapy, he developed recurrence of the primary lesion and pulmonary metastasis after about 6 months. We planned chemotherapy after performing gastrostomy for providing nutritional support . On the 5th day after the start of chemotherapy, the patient complained of breathlessness; chest computed tomography (CT) revealed mediastinal emphysema and fluid collection in the mediastinum. Based on these findings, we diagnosed the patient as having idiopathic esophageal perforation localized to the mediastinum, and opted for conservative treatment. The following day, the patient’s respiratory condition worsened, and a repeat CT was performed which revealed findings suggestive of perforation of the esophagus into the left thoracic cavity. Emergency surgery was performed. He was discharged from the hospital on the 78th day. Idiopathic esophageal perforation is a relatively rare benign disease that causes damage to all layers of the esophageal wall due to a sudden increase of the esophageal pressure. In this case, the perforation was considered as having been caused by the increased esophageal pressure due to nausea and vomiting, with the deteriorated nutritional status of the patient due to obstruction of the upper esophagus and long–term cancer treatment serving as contributory factors.
