A SURGICALLY CURED CASE OF POSTEMETIC RUPTURE OF THE ESOPHAGUS

Abstract

Spontaneous rupture of the esophagus often followed by vomiting is a grave disease which causes severe thoracic and/or upper abodminal pain. Yet, because of its relative infrequency, the diagnosis is often mistaken or delayed, resulting in the increased morbidity and mortality. A recent case of the disease cured by surgical treatment is reported together with a review of its literature. A 39-year-old man who often had nausea and vomitings after meals visited a practitioner because of sudden severe pain in the chest to epigastrium just after vomiting. The patient was referred to our department with a diangosis of cholelthiasis, however, abdominal ultrasonography and CT revealed no gallstones and ECG, chest and abdominal films also did not show any abnormal findings. Because of his excessive pain, sufficient endoscopical examination of the upper GI tract could not be made. However, subcutaneous and mediastinal emphysemas developed after the examination, and chest films showed a liquid collection and pneumothorax in the left thoracic cavity. Subsequent esophagofluoroscopy revealed a leakage of contrast medium to his left thoracic cavity from the lower esophagus. He immediately underwent thoracotomy with a diagnosis of rupture of the esophagus. The perforation site was sutured and closed. The postoperative course was uneventful and he was discharged on the 28th day after surgery.