Abstract
Perforation of the esophagus is an extremely rare but serious illness, which needs early diagnosis and appropriate treatment. We experienced a rare esophageal perforation into the right thorax with unique onset in a patient with an advanced esophageal cancer after a gastrectomy caused by vomiting. The problems of diagnosis and treatment, and the mode of its operation are reported. A 68-year-old man who was found to have a middle intra-thoracic esophageal cancer type 4+0-IIc+0-IIb after a wide gastrectomy was admitted to the hospital. Esophageal perforation into the right thorax occurred on vomiting aftre a meal. Therefore a total esophagectomy through a right thoraco-laparotomy with lymph node dissection RII, a cervical esophagostomy and a gastrostomy was carried out. The perforation site was the center of stenotic portion, was in the intraepithelial spread histopathologically. Because of an MRSA infection after the operation, complications like an abscess in the thoracotomy wound and osteochondritisdeveloped which were hard to cure. After improvement of the complication by evacuation of the abscess and chondrectomy, secondary reconstruction with a right colonic interposition between the cervical esophagus and the remnant stomach was carried out. We reported that second reconstruction was ableto be carried out to the case of esophageal perforation with esophageal carcinoma after the esophagectomy with lymph node dissection and appropriate drainage.
