Abstract
Spontaneous rupture of the esophagus commonly affects the lower thoracic esophagus. We herein report a rare case of spontaneous rupture of the upper-middle esophagus in the chest relieved by conservative therapy. A woman in her sixties was admitted to the hospital because of continuous chest pain after vomiting. She had been suffered from aortitis syndrome, taking 8 mg/day of PSL for approximately 40 years. Chest computed tomography (CT) showed air bubbles outside of the esophageal wall at the site of the tracheal bifurcation, while upper gastrointestinal endoscopy revealed a longitudinal ulcer in the upper to middle portion of the esophagus. Spontaneous rupture of the esophagus was highly suspected, however, the patient's mediastinitis was localized and her general condition had not deteriorated. Therefore, we treated her conservatively, maintaining the dose of steroids at 10 mg to control the aortitis syndrome.
After confirming a decrease in air bubbles on chest CT on the fourth hospital day, the patient was allowed to resume oral intake on the 15th hospital day. She was subsequently discharged from the hospital on the 43rd hospital day.
We speculate that vulnerability of the adjacent esophageal wall due to the patient's long history of aortitis syndrome and steroid treatment may have played an important role in the etiology of rupture in this case.
