Clinical Study of Spontaneous Esophageal Rupture, Four Cases Report

Kyouichi Mizutani, Hiroyasu Makuuchi, Takao Machimura, Hideo Shimada, Kouji Kanno, Hideki Moriya, Osamu Horie, Yoshio Sou, Takashi Sugihara, Hitoshi Hanaue, Tetsuji Sasaki, Tomoo Tajima, Toshio Mitomi

Second Department of Surgery, Tokai University School of Medicine

We experienced 4 cases of spontaneous esophageal rupture and conducted a clinical investigation on them, which is herein reported. The patients were all males, 40 to 63 years old. The rupture occurred on vomiting after alcohol intake in all 4 cases. A correct diagnosis was possible in 1 case only. One patient was treated conservatively and the other 3 were operated on. One patient who underwent surgery died of sepsis and the other 3 recovered and were discharged. For diagnosis, it is important to recognize the existence of this disease, and early use of chest X-ray photography, chest CT, and esophagography with Gastrographin is necessary. As for therapy, the cases that satisfy the following 4 conditions may be treated conservatively: 1) The rupture hole is relatively small; 2) the rupture is limited to the mediastinum; 3) contamination in the mediastinum is slight; 4) gastric contents are not continuously regurgitated. In cases other than the above, closure of the perforation, irrigation and accurate drainage of the thoracic and mediastinal cavities by surgery may be necessary as a rule.

Key words
spontaneous rupture of the esophagus, Boerhaave syndrome

Reprint requests
Kyouichi Mizutani Second Department of Surgery, Tokai University School of Medicine
Bouseidai, Isehara-shi, Kanagawa, 259-11 JAPAN

Accepted
September 9, 1992

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