Yukihiko Akita

A CASE OF SPONTANEOUS ESOPHAGEAL RUPTURE IN AN ELDER FEMALE

A case of spontaneous esophageal rupture in an elder female is reported. A 74-year-old female was admitted to the hospital because of dyspnea. Blood pressure was 79/29mmHg, and she was in shock state. Chest X-ray examination revealed expanded mediastinum and fluid collection in the right thoracic cavity. Chest tubes were inserted and fluid contained saburra was suctioned. CT scan showed dilatation and wall thickness of the lower esophagus, low density area around them, and fluid colleciton in bilateral thoracic cavities. After 51 hours from the onset, left thoracotomy and drainage of the mediastinum and thoracic cavity were done. The patient was diagnosed spontaneous esophageal rupture. After the operation, CT scan showed an increase in fluid in the right thoracic cavity. At 10th day after the surgery, same operation was done at right side. The patient began the ingestion on 17th day after the first operation, and was cured. One hundred and forty cases of spontaneous esophageal rupture were reported in Japan from 1985 to 1992. The ratio male and female is 16:1. Mean age is 49. Elder patient over 70 years old represents 3%. The cases of elder famle are rare. Some cases which were not diagnosed with esophagography have been reported like this cases, but CT scan was useful in diagnosing, selection of the treatment, and follow up after operation in this case. Effective drainaging is important on treatment.