Abstract
We report a case of recurrent spontaneous esophageal rupture in the right wall of the middle thoracic esophagus after following conservative treatment for spontaneous esophageal rupture in the left wall of the esophagus. A 74-year-old man admitted for acute onset of chest pain after swallowing was shown by chest X-ray to have mediastinal emphysema with an esophageal rupture about 2.5 cm long found esophagoscopy. The patient was treated conservatively with continuous drainage from a nasogastric tube inserted into the left mediastinal cavity. He recovered uneventfully and was discharged 19 days after admission. He began eating normally and was asymptomatic but was readmitted 5 days after discharg due to acute chest pain after vomiting. Computed tomography (CT) showed mediastinal emphysema on the right side of the esophagus, although chest X-ray showed no adnormal finding. The 0.5 cm esophageal rupture on the right wall of the middle esophagus was identified during esophagoscopy. Accurate diagnosis for both ruptures was made within 5 hours after onset aided particurally by CT. Spontaneous esophageal rupture in which mediastinal pleura is maintained is a good indication for conservative therapy, and transnasal continuous drainage proved to be effective. But careful attention should be paid to esophageal rupture recurrence after conservative therapy.
