J.Jpn. Surg. Soc.. 104(9): 606-610, 2003

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Feature topic

ETIOLOGY, DIAGNOSIS, AND TREATMENT OF SPONTANEOUS ESOPHAGEAL RUPTURE

In some unique cases ofidiopathic rupture of the esophagus where abscess is confined within the mediastinum and signs of infection are very slight the patient's life can be saved with conservative treatment. However, because idiopathic esophageal rupture is related to vomiting in many cases, contamination of the mediastinum and thoracic cavity by vomit is severe, and prompt diagnosis and early surgery are crucial to save the patient's life. Gastrointestinal contents from idiopathic esophageal rupture pour out via the mediastinum from the bilateral sides of the vertebral body to form extrapleural abscess on the wall side. During observation, the abscess may sometimes enlarge, progress, and extend. Therefore, several computed tomography scans and ECHO need to be performed followed by on-target drainage. Basically, idiopathic esophageal rupture cannot be cured by palliative treatment alone, and we need to undertake surgical treatment, as well as concomitant conservative treatments including blood purification (polymyxin, continuous hemodiafiltration), enteral feeding, and antibiotic therapy.

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