A Case Report of Esophageal Perforation into the Right Thorax with Advanced Esophageal Cancer Caused by Vomiting

Osamu Chino, Hiroyasu Makuuchi, Kyouichi Mizutani, Takao Machimura, Hideo Shimada, Kouji Kanno, Tetsuji Sasaki, Tomoo Tajima, Toshio Mitomi, Teruchi Sugita*

Second Department of Surgery, Tokai University School of Medicine
*Department of Surgery, Yamachika Hospital

Perforation of the esophagus is an extremely rare but serious illness, which needs early diagnosis and appropriate treatment. We experienced a rare esophageal perforation into the right thorax with unique onset in a patient with an advanced esophageal cancer after a gastrectomy caused by vomiting. The problems of diagnosis and treatment, and the mode of its operation are reported. A 68-year-old man who was found to have a middle intra-thoracic esophageal cancer type 4+0-IIc+0-IIb after a wide gastrectomy was admitted to the hospital. Esophageal perforation into the right thorax occurred on vomiting aftre a meal. Therefore a total esophagectomy through a right thoraco-laparotomy with lymph node dissection RII, a cervical esophagostomy and a gastrostomy was carried out. The perforation site was the center of stenotic portion, was in the intraepithelial spread histopathologically. Because of an MRSA infection after the operation, complications like an abscess in the thoracotomy wound and osteochondritis developed which were hard to cure. After improvement of the complication by evacuation of the abscess and chondrectomy, secondary reconstruction with a right colonic interposition between the cervical esophagus and the remnant stomach was carried out. We reported that second reconstruction was able to be carried out to the case of esophageal perforation with esophageal carcinoma after the esophagectomy with lymph node dissection and appropriate drainage.

Key words
perforation of esophagus, esophageal cancer, secondary reconstruction

Reprint requests
Osamu Chino Second Department of Surgery, Tokai University School of Medicine
Bohseidai, Isehara-shi, 259-11 JAPAN

Accepted
September 11, 1996

To read the PDF file you will need Abobe Reader installed on your computer.