Abstract
We report a case of spontaneous rupture of the esophagus in an elderly patient. An 84-year-old woman was seen at our emergency room because of upper abdominal pain. Chest X-ray showed left pleural effusion and wide mediastinum. Chest contrast enhanced CT scan revealed pneumomediastinum around the esohagus and pleural effusion. The diagnosis of spontaneous esophageal rupture was made. Emergency operation was performed about 20 hours after the onset of the disease. During the surgery, we found a longitudinal tear, 2 cm in length, in the left side of the lower esophagus and performed primary closure with reinforcement using intercostal muscle. After the operation anastomotic leakage occurred to form a localized abscess, which was cured by conservative treatments including fasting. However, the patient had MRSA pneumonia just before discharge and died on the 65th postoperative day.
Spontaneous rupture of the esophagus has relatively rarely been reported in elderly people. The prognosis of the disease is still poor in elderly patients, especially those over 80. In this case, gastroesophageal reflux might induce anastomotic leakage and postoperative pneumonia, and thus several treatment options should be considered.
