Contralateral Spontaneous Rupture of the Esophagus Following severe Vomiting After Non-intubated Pulmonary Wedge Resection

Abstract

Background: Non-intubated thoracoscopic lung surgery has been widely applied as it is technically feasible and safe. Spontaneous rupture of the esophagus, also known as Boerhaave's syndrome (BS), is rare after chest surgery.Case Presentation: A 60-year-old female non-smoker underwent non-intubated uniportal thoracoscopic wedge resection assisted with a laryngeal mask for a solitary pulmonary nodule. Ultrasound-guided serratus anterior plane block was utilized for analgesia. The patient complained of hyperemesis followed by chest pain and acute dyspnea 6 hours after the surgery. Emergency chest x-ray revealed the right-sided hydropneumothorax. BS was confirmed by further chest tube drainage and computed tomography. The patient refused surgical intervention; therefore, conservative procedures including pleural evacuation through a naso-leakage drainage tube, antibiotics and tube feeding were administered. The healing of the esophagus was recorded 40 days later.Conclusions: Perioperative antiemetic is an indispensable item of tubeless thoracic surgery. BS should be kept in mind when the patients suffer from sudden chest distress following severe vomiting after tubeless lung surgery.