A Case of Combined Thoracoscopic and Laparoscopic Surgery for Idiopathic Esophageal Rupture

Abstract

A 45-year-old woman presented with severe vomiting after dinner followed by back and chest pain. She was referred to us with the diagnosis of idiopathic esophageal rupture. A contrast study via a gastric tube revealed a rupture of the esophagus at its lower left side and a chest computed tomography revealed a giant mediastinal abscess accompanied by a contrast leakage and a moderate amount of left pleural effusion free from contrast. Her disease was diagnosed as contained rupture of the esophagus. She was operated on under two-lung ventilated general anesthesia in the right semilateral position. The abscess was drained by a laparoscopic transhiatal approach and lavaged with saline. Subsequently, a thoracoscopic exploration was performed via two port sites. It disclosed turbid effusion and enabled an adequate pleural lavage and drainage. A very small amount of extraluminal leakage was noted on an esophagogram on the 7th postoperative day which disappeared on the 14th. The patient was discharged home on the 22nd.

A contained rupture of the lower esophagus can be adequately drained by laparoscopic procedure, however, such cases may require an additional pleural exploration. A decubitus of right semi-lateral position would be suitable for this condition.