Spontaneous Esophageal Rupture: One Case Report And Review Of The Literature

ObjectiveTo have a better understanding of the clinic characteristics of spontaneous esophageal rupture,and improve the ability to make a correct diagnosis and treat.Clinic materials and methodsOne patient with spontaneous esophageal rupture was described and relevant literatures were review. ResultSpontaneous esophageal rupture is rare, predominantly caused by intense vomiting after over-eating and over-drinking(the case in this article is caused by intense vomiting after drinking too much).It also can be caused by delivery.asthma,strike of the back and fierce cough. Spontaneous esophageal rupture happened mostly in adult men. Patient's condition is severe,and has a bad prognosis,the case-fatality rate is high because of misdiagnosis, missed diagnosis and severe infection.The clinic manifestations have no specificity. The common manifestations include chest pain,dyspnea,hydropneumothorax,aerodermectasia and so on.The diagnosis of spontaneous esophageal rupture mainly depend on detailed case history and related auxiliary examination. The auxiliary examination mainly include:X-ray,CT,thoracic paracentesis or closed drainage, iodolography and diagnostic endoscopic examination. The differential diagnosis is very important due to its high misdiagnosis rate,it mainly be distinguished with hydropneumothorax, acute pancreatitis,acute cholecystitis, myocardial infarction and perforation of gastro-duodenal ulcer.About treatment,the first choice is surgical therapy,it have different operative procedures:simple closure operation;primary repair with tissue covered and strength,esophago-apokleisis; esophagectomy with anastomosis of esophague and stomach; ligation of carotid and abdominal esophagus;esophageal drainage.And concerning the patients with late onset, or general condition can not tolerate surgery, conservative treatment methods may be used.The case in this article,because it has a very long onset, and accompanied by bilateral empyema, is not suitable for surgical treatment.So we give conservative treatments,include:Gastrointestinal decompression, parenteral nutrition, bilateral closed thoracic drainage and esophageal stent, and at the same time do the right VATS empyema dissection, have good results.ConclusionSpontaneous esophageal rupture has a high rate of misdiagnosis and missed diagnosis.which often delay the optimal timing of surgery, bring difficulties to the treatment. Therefore, early diagnosis is one of the keys to reduce the complications of the disease and mortality. And clinical manifestations and associated auxiliary examinations are great help of the early diagnosis of spontaneous esophageal rupture. Select a reasonable treatment is closely related to the prognosis of the patient.