Surgical Management of Spontaneous Esophageal Rupture: An Evaluation

Abstract

Spontaneous esophageal rupture is rare. The distal esophagus ruptures upon a sudden vomiting-induced increase in the internal esophageal pressure. We evaluated surgical management of spontaneous esophageal rupture by examining clinical details and outcomes of 10 patients treated for the disorder at our hospital between 1987 and 2014.
Mean age of the patients was 58.1 years (range, 41–75 years). The sex ratio (M/F) was 9/1. Diagnosis was achieved by chest computed tomography (CT) or chest CT and esophagography. The rupture occurred in the left lower thoracic esophagus (n=8), left middle thoracic esophagus (n=1), or right lower thoracic esophagus (n=1). Mean time from symptom onset to surgery was 36.2 hours (range, 5–96 hours).
Patients were divided between those treated within 24 hours of onset (early treatment group, n=5) and those treated 24 hours or more after onset (late treatment group, n=5). Treatment comprised primary repair in 7 patients and esophagectomy in 3. Postoperative complications occurred in 6 patients: surgical site infection (n=4), anastomosis leakage (n=3), intrapleural abscess (n=1), sepsis (n=1), and pneumonia (n=1). Mean postoperative hospital stay was78.5 days (range, 22–228 days). There was no in-hospital mortality.
Postoperative complications were somewhat more frequent in the late treatment group (n=4, 80%) than in the early treatment group (n=3, 60%), and postoperative hospital stay was longer in this group (114.2 vs. 42.8 days). Outcomes in terms of postoperative complications and hospital stay were good in the early treatment group. In the late treatment group, severe intrathoracic contamination in 3 patients necessitated life-saving esophagectomy. When primary repair was performed, the incidence of anastomotic leakage was lowest when both layers were sutured, perforation sites were reinforced, and nutritional support was provided.
Early diagnosis and treatment are essential for spontaneous esophageal rupture, and we believe that selecting the appropriate surgical technique increases survival.