A Case of Spontaneous Esophageal Rupture to Thoracic Cavity Treated with Non-thoracotomy Drainage and Enteral Nutrition

Abstract

A 63-year-old woman was brought into our hospital by ambulance because of vomiting after dinner and subsequent chest and back pain. A chest CT scan revealed left pneumothorax with pleural effusion and periaortic mediastinal emphysema. Esophagogram showed extravasation of contrast medium from the esophagus into the thoracic cavity. Spontaneous esophageal rupture was diagnosed. The patient was a candidate for surgery, but she refused to undergo surgery which entailed a possibility of blood transfusion owing to her religious reason. Accordingly after complete fasting and administration of antibiotics, we inserted an elemental diet tube equipped with vaccum lumen as well as two thoracic drains under thoracoscopy. Her general condition was unstable, but intrathoracic lavage and tube feeding were performed. Esophagography conducted on the 48^th hospital day confirmed disappearance of leakage of contrast medium. Oral intake was resumed and she was discharged from our hospital on the 81^st hospital day.
Spontaneous rupture of the esophagus with thoracic perforation is associated with high mortality and requires emergency surgery as a rule. However, appropriate intrathoracic drainage and enteral nutrition using an elemental diet tube equipped with vaccum lumen could be a choice of therapy.