A Case Report of the Successful Conservative Therapy for the Spontaneous Esophageal Rupture with Early Presentation

Tsunemasa Takishima, Hiroyoshi Mieno*, Yoshisuke Nakayama*, Hideto Tsukamoto*, Yasushi Asari, Mitsuhiro Hirata, Idumi Sakamoto*, Kensho Ogawa*, Koshi Sato*, Yoshiki Hiki*, Akira Kakita*

The Department of Emergency and Critical Care Medicine, Kitasato University, School of Medicine
*The Department of Surgery, Kitasato University, School of Medicine

We report a patient with successful conservative therapy for spontaneous esophageal rupture who was admitted 7 hours after onset with stable vital signs. The patient, a 59-year-old man, vomited several times followed by severe epigastralgia. Both plain chest X-ray and CT on admission revealed pneumomediastinum and a small amount of pleural effusion without pneumothorax. UGI using watersoluble contrast medium or 20% barium showed no extravasation from the esophagus. On day 3, although UGI revealed obvious contrast extravasation from the lower esophagus, the contrast medium did not leak beyond the mediastinum into the pleural cavity. Bacteriological study of the pleural effusion was negative. Therefore, conservative therapy was continued and diet was started on day 64, when UGI and endoscopic examinations showed nearly the healing stage. He was discharged on day 78 in good general condition. The majority of previous reports have mentioned that conservative therapy for spontaneous esophageal rupture is indicated when the definite diagnosis has been delayed for several days or more, or when the patient's general condition is poor on admission. We conclude that conservative therapy would be successful when mediastinal contamination is localized without mediastinal abscess and pyothorax in the acute phase of this disease.

Key words
spontaneous esophageal rupture, Boerhaave's syndrome, conservative therapy

Reprint requests
Tsunemasa Takishima Department of Emergency and Critical Care Medicine, Kitasato University, School of Medicine
1-15-1 Kitasato, Sagamihara, 228 JAPAN

Accepted
October 12, 1994

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