A Case of Rupture of the Thoracic Lower Esophagus Found Out after Blunt Trauma

Takehiro Sakai, Koichi Sato, Akihito Kon and Yasuhiro Sudo

Department of Surgery, Hirosaki City Hospital

A 71-year-old woman, taking methotrexate for rheumatoid arthritis, lost consciousness after falling while bathing. After recovering consciousness, she reported severe chest pain and dyspnea, and was found in chest CT to have left hydropneumothorax and thickening of the lower thoracic esophagus, although no other traumatic lesions were detected. Left thoracic drainage indicated saburra. Esophageal endoscopy confirmed perforation of the lower thoracic esophagus. Emergency thoracotomy showed that the left wall of the lower thoracic esophagus had ruptured for 3.5 cm. The perforation was closed directly followed by irrigation and drainage. Postoperative esophageal radiography showed neither anastomotic leakage nor stenosis. Although the patient suffered from wound infection and insufficient daily activity postoperatively, she was discharged as ambulatory on postoperative day 58. The mechanism of esophageal rupture in this patient was considered to be a sudden increase in luminal pressure of the esophagus due to falling, because no symptoms which led to increase in intraabdominal pressure were noticed before losing consciousness and falling. Esophageal rupture should therefore be considered in patients with blunt trauma.

Key words
blunt trauma, esophageal rupture, methotrexate

Reprint requests
Takehiro Sakai Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine
5 Zaifu-cho, Hirosaki, 036-8562 JAPAN

Accepted
November 28, 2007

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