A CASE OF SPONTANEOUS PUPTURE OF THE ESOPHAGUS WITHOUT LEAKAGE ON THE FIRST ESOPHAGOGRAPHY

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  • 初診時の上部消化管造影で所見を認めなかった,特発性食道破裂の1例

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Abstract

A 69-year-old male was admitted to the hospital because of a severe chest pain. A chest X-ray film and esophagography on the first visit did not reveal spontaneous rupture of the esophagus, but a little amount of mediastinal emphysema was revealed by CT. After admission, significant amount of pleural effusion was seen on chest X-ray, and drainage was performed. Food residue was noted in the liquid from the chest tube. Esophagography 20 hours after admission revealed a leakage in the lower portion of the esophagus, which was diagnosed as spontaneous rupture of the esophagus. Under general anesthesia, two drains were insterted to the left. thoracic cavity and gastrostomy was performed. The rupture site of the esophagus was sutured.<br> In a review of clinical cases seen in the literature, we would propose the following two strategies for the diagnosis and treatment of spontaneous rupture of the esophagus. Strategy 1: When we encounter patients with sudden onset of chest pain or upper abdominal pain, chest and upper abdominal CT should be performed routinely, and subsequently esophagography should be done for probable occurrence of the disease, if mediastinal emphysema is confirmed on CT. Even if no abnormality is revealed, these patients should be followed up by chest X-ray examination and esophagography. Strategy 2: When the rupture of the esophagus is diagnosed, emergency operation and devised closure of the rupture site are needed.

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