SPONTANEOUS RUPTURE OF THE ESOPHAGUS-TWO SURGERY AND ONE CONSERVATIVELY TREATED CASES-

Abstract

Spontaneous rupture of the esophagus is a relatively rare entity. It is said that the disease follows a fatal course unless appropriate treatments in the early stage. We experienced three cases of the disease, of which two cases were surgically and one cases was conservatively treated. Of the two operated cases, primary closure was performed in one case and the suture site was covered with a pedicled omental flap in another case. Their postoperative courses were uneventful and the two patients were discharged. Conservative therapy without mediastinal and thoracic drainage was performed in the remaining patient, who was an 85-year-old man that was the oldest in the Japanese literature so far. He was discharged from the hospital in good general condition. In a review of 78 cases, including our cases, reported in Japan from 1993 to 1997, a comparison of the primary closure group with the covering method group in cases operated on within 24 hours after the onset of the disease. the occurrence rate of the anastomotic breakdown was significantly lower in the latter group than that of the former. We think that in some cases diagnosed as the disease early, the covering method should be performed rather than primary closure.