A Case of Rupture of the Esophagus in a Patient with Superficial Esophageal Cancer -Successful Treatment by Esophagectomy with Lymph Node Dissection-

Yoshihiro Kinoshita, Masahiko Tsurumaru, Harushi Udagawa, Yoshiaki Kajiyama, Kenji Tsutsumi, Masaki Ueno, Hiroshi Akiyama, Yoshio Hoshihara*

Department of Surgery, Toranomon Hospital
*Department of Gastroenterology, Toranomon Hospital

It is generally believed that there is a close relationship between mortality after esophageal rupture and the time between the onset of symptoms and initial treatment. We recently encountered a 53-year-old man with rupture of the esophagus. A diagnosis of superficial esophageal cancer with possible invasion to the muscularis mucosa had been made, and the patient was scheduled for surgical resection. He developed severe epigastric and back pain after vomiting his first meal following fiberoptic esophagoscopy, and we diagnosed rupture of the esophagus based on the chest X-ray and computed tomography findings within 4 hours of the onset of symptoms. Superficial esophageal cancer that has invaded beyond the muscularis mucosa is said to require esophagectomy with lympn node dissection because of possible nodal metastasis. In this case, we thought that it would be very difficult to perform lymph node dissection as a second stage operation after esophagectomy because of severe adhesions. Accordingly, we resected the esophagus and performed lymph node dissection with simultaneous reconstruction and attributed the successful outcome to less extensive mediastinitis and the patient's stable general condition. The postoperative course was uneventful. Simultaneous esophagectomy plus lymph node dissection and reconstruction can be an option in the surgical management of esophageal perforation in patients with esophageal cancer.

Key words
superficial esophageal cancer, rupture of the esophagus, simultaneous resection with lymph node dissection and reconstruction

Reprint requests
Yoshihiro Kinoshita Department of Surgery, Toranomon Hospital
2-2-2 Toranomon, Minatoku, Tokyo, 105 JAPAN

Accepted
May 21, 1997

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