TWO CASES OF SPONTANEOUS ESOPHAGEAL RUPTURE AND SUGGESTIONS FOR TREATMENT

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  • 治療上の示唆に富んだ特発性食道破裂の２例

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We report two cases of spontaneous esophageal rupture that were suggestive about treatment. The first patient was a 53-year-old male who vomited after consuming alcohol immediately followed by dorsalgia and dyspnea. A CT scan revealed left pleural effusion, pneumothorax and pneumomediastinum. Nine hours after presentation, the esophageal rupture was closed with a primary suture via a right thoracotomy. Because the patient had severe liver cirrhosis and esophageal varices, controlling perioperative hemorrhaging was difficult. The patient died 6 hours postoperatively with multiple organ failure. The second patient was a 55-year-old male in whom esophageal rupture was suspected under similar circumstances as the first case. Seven hours after presentation the rupture was closed with a primary suture and covered with a pedicled muscle flap of the intercostal muscle via a right thoracotomy. Treatment was complicated by leakage of the sutures and associated bilateral pyothorax. The condition was conservatively recovered with intravenous nutritional management. As for the spontaneous esophageal rupture, early diagnosis and immediate treatment influence the prognosis, but treatment suffered due to the inadequate approach to the underlying disease regardless of an early diagnosis. The treatment for esophageal rupture is standardized, but it is important to treat with low infestation mainly on drainage for the overall case, and to choose on adequate method for the case.

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