A Case of Spontaneous Esophageal Rupture Treated by Transhiatal Gastric Fundus Patch Placement via a Thoracotomy Approach

Abstract

A 76-year-old male patient was rushed to his previous physician with the complaints of left chest pain and chills. On the same night, the patient’s respiratory condition deteriorated rapidly, and he was diagnosed as having idiopathic esophageal rupture after a pleural fluid analysis revealed food residue. Fifty-four hours after the symptom onset, the patient was transferred to our hospital for emergency surgery. On approaching through a left thoracotomy, a 5 cm long esophageal tear was observed on the left wall of the lower thoracic esophagus, 2 cm from the diaphragmatic leg. After performing a simple closure, we created a patch using the gastric vault and performed a catheter jejunostomy through a small laparotomy wound. Postoperatively, the patient required drainage of the residual abscess, but was discharged on the 57th day. Various approaches to idiopathic esophageal rupture and methods of rupture site closure have been reported in the literature. In a retrospective study of 340 cases retrieved from the Igaku Chuo Zasshi (Ichushi-Web), the suture failure rate tended to be lower in patients who underwent repair via an open chest approach rather than via a thoracoscopic approach, by the two-layer suture approach rather than by the one-layer suture approach, and by the cover technique rather than by non-cover technique. Thus, a two-layer suture closure using a cover technique may be the preferred approach for the treatment of idiopathic esophageal rupture.