A Case of an Elderly Woman Who Underwent Surgery by the Minimally Invasive Abdominal and Left Thoracic Approach (MALTA) for Spontaneous Esophageal Rupture (Extra-Mediastinal Type)

Abstract

A 76-year-old woman presented to our hospital complaining of acute-onset breathlessness and left-sided chest pain. Contrast-enhanced computed tomography revealed mediastinal emphysema, left pleural effusion, and partial rupture of the lower esophagus. She was referred to our department and diagnosed as having spontaneous esophageal rupture of the extra-mediastinal type. We performed emergency surgery, initially via a laparoscopic approach. As it was difficult to dissect the area around the esophageal hiatus due to severe inflammation, the procedure was converted to hand-assisted laparoscopic surgery (HALS), and the ruptured area on the left wall of the lower esophagus was sutured. Then, thoracoscopy-assisted drainage of the thoracic cavity and upper mediastinum was performed to drain the large amount of food residue in the thoracic cavity. The patient received postoperative intensive care due to sepsis, recovered well without pulmonary complications, and was transferred to a local hospital on the 34th postoperative day. Adoption of the minimally invasive abdominal and left thoracic approach (MALTA) can be effective for treating spontaneous esophageal rupture of the extra-mediastinal type in the elderly, and HALS may also be useful to avoid conversion to laparotomy and thoracotomy, and for enabling minimally invasive surgery even in the presence of severe local inflammation.