A case of spontaneous esophageal rupture improved by conservative treatment and followed up by endoscopy

Abstract

A 56-year-old man was admitted to our hospital because of vomiting after drinking and subsequently a fever and anterior chest pain at swallowing. Endoscopic picture showed longitudinal laceration at the posterior wall of the lower esophagus. Chest CT scan revealed inflammatory esophageal wall thickness and a small amount of pleural effusion. According to the clinical course, endoscopic findings and CT findings, spontaneous esophageal rupture was diagnosed. The patient's physical condition was good even after 24 hours following the onset. Chest pain occurred only during swallowing. In addition, CT scan did not detect mediastinitis or mediastinal emphysema. Thus, we performed conservative treatment. Symptoms and test results showed improvement, he was discharged from the hospital on the 28th day. Surgery is the primary treatment of spontaneous esophageal rupture, however, conservative treatment is applicable in cases that the rupture is limited in the mediastinum and the physical condition of the patient is good.