A patient with spontaneous rupture of the esophagus and concomitant gastric cancer whose life was saved: case of report and review of the literature in Japan

Abstract

A 71-year-old man suddenly developed abdominal pain and vomiting on drinking soda after a meal, and visited a physician. Cervical subcutaneous and mediastinal emphysemas were observed on CT, and the patient was transferred to the emergency medical center of our hospital on the same day. Esophagography was performed at our department. A ruptured region was identified on the left side of the lower thoracic esophagus, and surgery was emergently performed employing sequential left thoracoabdominal incision. The chest wall was adhered due to inflammation, and large amounts of residual food and sloughing were present in the thoracic cavity and mediastinum. Moreover, necrotic changes were noted in the superior through inferior mediastinum. An about 2-cm rupture site was confirmed on the left side of the lower thoracic esophagus and closed by suture and filling with pediculate omentum. The presence of a tumorous lesion located mainly in the body of the stomach and lymph node enlargement were also diagnosed before surgery, for which gastric and intestinal fistulae were inserted to prepare for the second-stage surgery. The patient was admitted to an ICU after surgery. ARDS and MRSA-induced pneumonia and enteritis concomitantly developed but remitted. Curative surgery for gastric cancer was performed at 40 POD. Spontaneous rupture of the esophagus is relatively rare and that complicated by gastric caner is very rare, with only six cases being reported in Japan. Herein, we report the case.

Gastric Perforation: A Rare Presentation of Malignant Gastric Outlet Obstruction

“…Malignant GOO can lead to perforation of the stomach or the esophagus. There have been case reports of esophageal perforation secondary to malignant GOO, and the location of all the tumors was found to be in the pre-pyloric region [8][9][10]. There have been case reports of gastric perforation due to gastric obstruction [11].…”

Esophageal perforation secondary to malignant gastric outlet obstruction: a case report

“…This is the tenth reported case of esophageal perforation secondary to gastric outlet obstruction (GOO) from gastric cancer and the first to be temporized by esophageal and pyloric stenting with transluminal perforation management. Previously, Matsuhashi and colleagues [4] published the first English language case report of esophageal perforation secondary to malignant GOO. Their 2011 literature review identified five other similar cases.…”

An unusual approach for the treatment of oesophageal perforation: Laparoscopic-endoscopic cooperative surgery

“…[1314] Tissues such as the intercostal muscles, pleura, omentum and pericardium pedicle flaps may be used to strengthen the repair line in the perforated area, but discussions about their efficacy remain. [1516] The sternothyroid and sternocleidomastoid muscles may also be used in cervical oesophagus perforation. [17]…”