Abstract
Four cases of spontaneous repture of the esophagus experienced in a past 5-year period is described. All patients, were meales aged 44-62 years, and complained of severe upper abdominal pain and chest pain just after several vomits. Three patients were not diagnosed in an early stage of the disease. Possible esophageal rupture was suspected from the laboratory findings of pleural effusion in Case 1, 2 and 3. Definitive diagnosis was obtained from fluoroscopy in Case 1 and 2. Endoscopic examination was effectively performed in Case 3 and 4. Computed tomography used in Case 4 early detected bilateral pleural effusion and mediastinal emphysema. In Case 2, primary suture of the perforation and thoracic drainage were performed but mediastinitis deteriorated by the infection of methycillin resistant Staphylococcus aureus was uncotrolable. After considering this failur in the case 2, in the treatment of case 3 and 4, resection of the thoracic esophagus was selected and the posterior mediastinum was left open for the thoracic drainage, followed by the second operation for reconstruction. From the above experience, we are convinced that esophagectomy is necessary to decrease the mortality in the case diagnosed lately.
