Abstract
A 47-year-old woman who presented with anemia seven months prior and was diagnosed with a huge ulcer on the duodenal bulb, edematous swelling-related pylorus stricture, reflux esophagitis and stricture of the lower esophagus. Treatments with PPI and balloon expansion at the lower esophagus were effective. She was admitted emergently because of vomiting (blood-related vomitus) and sudden backache. Chest and abdominal computed tomography (CT) scans showed mediastinal emphysema and bilateral hydrothorax, wall thickening of the duodenal bulb and significant gastrectasia. Esophagram showed leakage of contrast medium to the inferior mediastinum and bilateral thoracic cavity from the lower esophagus. We conducted emergency surgery based on the diagnosis of spontaneous esophageal rupture, followed by primary closer and omental patch. The woman was discharged on the 67th day. Following exacerbation of the pylorus stricture by the duodenal ulcer and reflux esophagitis, it appeared that vomiting had triggered the esophageal rupture. The need for early surgical management in consideration of the pyloric stenosis was suggested.
