A Case of Spontaneous Esophageal Rupture Treated with Surgery on Day 13 which Resulted in the Life-saving

Abstract

Spontaneous esophageal rupture is a disorder requiring urgent care in which the prognosis is affected by rapid diagnosis and treatment. A patient with spontaneous esophageal rupture who underwent surgery after receiving conservative therapy for a diagnosis of acute empyema is reported. The patient was a 73-year-old man who was brought to our hospital on an emergency basis after vomiting at home and experiencing persistent chest pain and dyspnea. Chest X-ray showed left pneumothorax and pleural effusion, and a thoracic drain was inserted. When pleural lavage was initiated based on a diagnosis of acute empyema, food residues were also observed. Esophagography showed leakage of contrast agent from the left wall of the lower thoracic esophagus. Endoscopy revealed a large laceration from which the inside of the thoracic cavity could be seen at the rupture site, and a large abscess cavity having poor drainage was confirmed. Suture closure of the esophageal rupture site and attachment of the gastric fundus over the closed site using the left thoracotomy approach were performed on day 13, and the patient was discharged on postoperative day 30 in good condition. In cases of spontaneous esophageal rupture for which conservative therapy has failed surgery should be considered including appropriate (inventive) suturing and drainage methods even if a long period of time has elapsed since onset.