A Case of Spontaneous Esophageal Rupture which Relapsed after Conservative Therapy

Yutaka Nakata, Tatsuhiro Ishii and Noriaki Tomioka

Department of Surgery, Kitaishikai Hospital

We report a case of recurrent spontaneous esophageal rupture in the right wall of the middle thoracic esophagus after following conservative treatment for spontaneous esophageal rupture in the left wall of the esophagus. A 74-year-old man admitted for acute onset of chest pain after swallowing was shown by chest X-ray to have mediastinal emphysema with an esophageal rupture about 2.5 cm long found esophagoscopy. The patient was treated conservatively with continuous drainage from a nasogastric tube inserted into the left mediastinal cavity. He recovered uneventfully and was discharged 19 days after admission. He began eating normally and was asymptomatic but was readmitted 5 days after discharg due to acute chest pain after vomiting. Computed tomography (CT) showed mediastinal emphysema on the right side of the esophagus, although chest X-ray showed no adnormal finding. The 0.5 cm esophageal rupture on the right wall of the middle esophagus was identified during esophagoscopy. Accurate diagnosis for both ruptures was made within 5 hours after onset aided particurally by CT. Spontaneous esophageal rupture in which mediastinal pleura is maintained is a good indication for conservative therapy, and transnasal continuous drainage proved to be effective. But careful attention should be paid to esophageal rupture recurrence after conservative therapy.

Key words
spontaneous esophageal rupture, conservative therapy

Reprint requests
Yutaka Nakata Department of Surgery, Kitaishikai Hospital 2633-3 Tokunomori Ozu, Ehime, 795-0061 JAPAN

Accepted
October 31, 2000

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