A Case of Right-sided Esophageal Rupture Successfully Treated by Esophagectomy and One-stage Reconstraction

Abstract

Esophageal rupture predominately occurs on the left side, and there are few reports about the mechanism of right-sided occurrence and the treatment strategies. A 66-year-old man with a history of esophageal stenosis caused by chronic reflux esophagitis was brought into another hospital by ambulance because of back pain. He was diagnosed with suspected esophageal rupture on computed tomography, thus he was transferred to our hospital. The patient was diagnosed with right-sided intrapleural perforating esophageal rupture on esophagography, and we decided to perform an emergency surgery. A large amount of contaminated pleural effusion and debris were found in the right pleural cavity, and an approximately 5-cm longitudinal tear was identified in the right-sided wall of the lower thoracic esophagus. Considering the risk of re-rupture and leakage, we performed subtotal esophagectomy and gastric tube reconstruction via a retrosternal route. Postoperatively, the clinical course was good without any complications. The weakness of the right-sided wall of the esophagus due to chronic inflammation was indicated histopathologically, and that was thought to have been the cause of the right-sided esophageal rupture. This case suggests that esophagectomy and one-stage reconstruction can be a treatment choice for esophageal rupture in generally stable patients.