Abstract
The patient was a 74-year-old man who underwent surgery for esophageal cancer. He developed bilateral pneumothorax, mediastinal emphysema, subcutaneous emphysema and severe pneumoperitoneum, as revealed by examination, and was hospitalized. The peritoneal irritation sign was not present and there was no inflammation. We judged indications for emergency surgery to be absent. We conducted chest drainage and administered antibiotics, together with follow up. Lung expansion was good. However, two weeks passed and air leakage persisted, with CT showing a bulla in the middle lobe. Thus, surgery was indicated. The bulla seen on CT was resected. In the diaphragm vicinity, we were able to confirm a gastric tube without adhesion to the circumference. It was thought that these findings had resulted from the air which came from the right spontaneous pneumothorax via the gastric tube circumference, which then entered the abdominal cavity, mediastinum and contralateral pleural cavity. We discussion this case herein.
