A CASE OF TRAUMATIC ESOPHAGEAL RUPTURE FOLLOWING POSTERIOR FRACTURE-DISLOCATION OF THE THIRD THORATIC SPINE

Abstract

A 48-year-old woman injured in an automobile accident sustained posterior fracture-dislocation of the third thoracic vertebra with no spinal paralysis and multiple rib fractures. Dyspnea witout apparent cause necessitated tracheostomy. Contrast study was done because of purulent pleural effusion on the 8th day. Diagnosis of esophageal rupture at the fracture site of the vertebra was made. Chest drainage tubes were inserted into the both pleural cavities and parenteral antibiotics were started. This drainage seemed effective judging from the findings of contrast studies and chest-CTs, but the direct communication between the fracture portion of the vertebra and the esophageal rupture remained as a fistula.
The patient developed pneumonia following by DIC and she eventually died. Although the so-called "golden time" had passed when the exact diagnosis was made in this patient, an early surgical intervention might have been better than the conservative treatment. Esophageal rupture following the vertebral fracture is very rare and this seems to be the first reported case in Japan.