Abstract
A 38-year old unmarried female was admitted to our institute on March 29, 1984, with dyspnoea and severe anterior chest pain. She had had symptoms of a duodenal ulcer and gall stones, and also had a history of alcohol abuse during the past several years. Two hours after gastroscopy, she drank a glass of whisky, immediately became nauseated, vomited a small amount of brilliant red blood and suddenly developed dyspnoea, peripheral cyanosis and anterior chest pain. One hour later, she was found to have subcutaneous emphysema in the supraclavicular region, and was transferred to our hospital with a diagnosis of suspicious perforation of the esophagus. Shortly after admission, an upright chest film revealed left pleural effusion.
Gastrographin esophagograms showed leakage from the lower esophagus to the mediastinum. Eight hours after the onset of these symptoms, she underwent left thoracotomy. A 2cm longitudinal full-thickness tear was found on the left lateral aspect of the esophagus approximately 3cm above the diaphragm. Closure by a two-layered technique with 3-0 Dexon and drainage were performed. Her postoperative course was uneventful. She was discharged 3 weeks after the operation. The best prognosticator for the successful outcome in the treatment of this disease is early recognition of the problem. The importance of diagnosis as a prerequisite for successful treatment is emphasized.
