Spontaneous rupture of the esophagus in an eldery patient complicated by pulmonary abscess and inflammatory arteriorrhexix—report of a case—

Abstract

We experienced a case of spontaneous rupture of the esophagus complicated by pulmonary abscess with inflammatory arteriorrhexis.
An 85-year-old man visited a local physician because of anorexia and cough. On chest radiography, pulmonary abscess was suspected, and antibiotic therapy was started. The treatment was ineffective and he was referred to our hospital for further examination and medication. Upper gastrointestinal endoscopy showed no abnormality, but the gastrografin swallow showed extravasation from the esophagus which led us to the diagnosis of mediastinitis caused by spontaneous rupture of the esophagus. Emergency operation was performed. We found a longitudinal tear, 1cm in length, in the left side of the lower esophagus and then started drainage using a T-tube. On postoperative day (POD) 14, massive hemorrhage was seen through the thoracostomy tube and emergency operation was performed again. We found arteriorrhexis caused by inflammation of the descending aorta. It was difficult to control the bleeding, and so we selected fenestration drainage. Seven days later, the patient died of massive hemorrhage from the arteriorrhexis. Spontaneous rupture of the esophagus in elderly people often become serious because it lacks typical symptoms and test findings, with resultant delayed diagnosis. In selecting therapies for them, allowance must be made for the extent of invasiveness of the therapies.