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Successful surgical treatment of a spontaneous rupture of the esophagus diagnosed two days after onset.

Ando H, Shitara Y, Hagiwara K, Hara K, Mogami Y, Kobayashi T, Yajima T, Tani M, Morinaga N, Ishizaki M, Kuwano H - Case Rep Gastroenterol (2012)

Bottom Line: These results confirmed a rupture of the esophagus, and an emergency left thoracotomy was performed.The perforation was repaired with a single-layered closure and was covered with elevated great omentum obtained by laparotomy.The patient was discharged 23 days after the first surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Fujioka General Hospital, Fujioka, Gunma University, Maebashi, Japan.

ABSTRACT
Esophageal perforation is a relatively uncommon disease with a high rate of mortality and morbidity. Delay in the diagnosis and treatment occurs in more than 50% of cases, leading to a mortality rate of 40-60%. Primary repair is generally considered the gold standard for patients who present within the first 24 h following perforation of the esophagus. In this paper, we present a case of successful surgical treatment of spontaneous rupture of the esophagus that was diagnosed 2 days after onset. The patient was a 42-year-old man admitted to internal medicine with a diagnosis of pleuritis and complaining of chest and back pain. The next day, computed tomography revealed left-sided pleural effusion and mediastinal emphysema. An esophagogram revealed extravasation of the contrast medium from the lower left esophagus to the mediastinal cavity. These results confirmed a rupture of the esophagus, and an emergency left thoracotomy was performed. The perforation was repaired with a single-layered closure and was covered with elevated great omentum obtained by laparotomy. The patient was discharged 23 days after the first surgery. In conclusion, primary repair surgery must be selected as the best treatment beyond 24 h if the patient's general state was stable and there was no evidence of clinical sepsis.

No MeSH data available.


Related in: MedlinePlus

An esophagogram revealed extravasation of contrast medium (Gastrografin) from the lower left esophagus to the mediastinal cavity.
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Figure 2: An esophagogram revealed extravasation of contrast medium (Gastrografin) from the lower left esophagus to the mediastinal cavity.

Mentions: A 42-year-old man visited a nearby hospital with severe chest and back pain after vomiting. Electrocardiography findings were not typical of acute myocardial infarction. Computed tomography (CT) showed slight left pleural effusion. The patient was admitted to our hospital with a diagnosis of pleuritis. The next day, the pain gradually worsened. CT was reexamined, revealing a large amount of pleural effusion on the left side and mediastinal emphysema (fig. 1). An esophagogram revealed extravasation of the contrast medium (Gastrografin) from the lower left esophagus to the mediastinal cavity (fig. 2). These results confirmed a rupture of the esophagus, and an emergency left thoracotomy was performed 31 h after the onset of symptoms. A 5-cm perforation was discovered in the left lateral wall of the lower esophagus (fig. 3a). The perforation was repaired with a single-layered closure (fig. 3b) and covered with elevated great omentum obtained by laparotomy (fig. 3c). In the 7 days after the surgery, laboratory examinations showed the following abnormalities: white blood cells 20,640 and C-reactive protein 11.4. An esophagogram revealed no extravasation. CT showed a residual abscess, or empyema, on the left side. Treatment involved drainage by video-assisted thoracic surgery, and oral intake was started the next day. The patient was discharged 23 days after the first surgery.


Successful surgical treatment of a spontaneous rupture of the esophagus diagnosed two days after onset.

Ando H, Shitara Y, Hagiwara K, Hara K, Mogami Y, Kobayashi T, Yajima T, Tani M, Morinaga N, Ishizaki M, Kuwano H - Case Rep Gastroenterol (2012)

An esophagogram revealed extravasation of contrast medium (Gastrografin) from the lower left esophagus to the mediastinal cavity.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3369410&req=5

Figure 2: An esophagogram revealed extravasation of contrast medium (Gastrografin) from the lower left esophagus to the mediastinal cavity.
Mentions: A 42-year-old man visited a nearby hospital with severe chest and back pain after vomiting. Electrocardiography findings were not typical of acute myocardial infarction. Computed tomography (CT) showed slight left pleural effusion. The patient was admitted to our hospital with a diagnosis of pleuritis. The next day, the pain gradually worsened. CT was reexamined, revealing a large amount of pleural effusion on the left side and mediastinal emphysema (fig. 1). An esophagogram revealed extravasation of the contrast medium (Gastrografin) from the lower left esophagus to the mediastinal cavity (fig. 2). These results confirmed a rupture of the esophagus, and an emergency left thoracotomy was performed 31 h after the onset of symptoms. A 5-cm perforation was discovered in the left lateral wall of the lower esophagus (fig. 3a). The perforation was repaired with a single-layered closure (fig. 3b) and covered with elevated great omentum obtained by laparotomy (fig. 3c). In the 7 days after the surgery, laboratory examinations showed the following abnormalities: white blood cells 20,640 and C-reactive protein 11.4. An esophagogram revealed no extravasation. CT showed a residual abscess, or empyema, on the left side. Treatment involved drainage by video-assisted thoracic surgery, and oral intake was started the next day. The patient was discharged 23 days after the first surgery.

Bottom Line: These results confirmed a rupture of the esophagus, and an emergency left thoracotomy was performed.The perforation was repaired with a single-layered closure and was covered with elevated great omentum obtained by laparotomy.The patient was discharged 23 days after the first surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Fujioka General Hospital, Fujioka, Gunma University, Maebashi, Japan.

ABSTRACT
Esophageal perforation is a relatively uncommon disease with a high rate of mortality and morbidity. Delay in the diagnosis and treatment occurs in more than 50% of cases, leading to a mortality rate of 40-60%. Primary repair is generally considered the gold standard for patients who present within the first 24 h following perforation of the esophagus. In this paper, we present a case of successful surgical treatment of spontaneous rupture of the esophagus that was diagnosed 2 days after onset. The patient was a 42-year-old man admitted to internal medicine with a diagnosis of pleuritis and complaining of chest and back pain. The next day, computed tomography revealed left-sided pleural effusion and mediastinal emphysema. An esophagogram revealed extravasation of the contrast medium from the lower left esophagus to the mediastinal cavity. These results confirmed a rupture of the esophagus, and an emergency left thoracotomy was performed. The perforation was repaired with a single-layered closure and was covered with elevated great omentum obtained by laparotomy. The patient was discharged 23 days after the first surgery. In conclusion, primary repair surgery must be selected as the best treatment beyond 24 h if the patient's general state was stable and there was no evidence of clinical sepsis.

No MeSH data available.


Related in: MedlinePlus