Spontaneous Rupture of the Oesophagus

Abstract

IT IS AXIOMATIC in medicine that increased awareness of a disease leads to its increased recognitio n. This is particularly exemplified in spontaneous rupture of the oesophagus.Although the subject has been fairly extensively reviewed in the literature, cases of this disease are often missed.The condition is relatively rare and its presenting symptoms may be atypical.Surgical repair (Barrett, 1946(Barrett, , 1947, is the treatment of choice. Whilst good results will depend on early diagnosis it is perhaps not so generally recognized that surgery can be reasonably attempted even when the patient's condition appears desperate.A dramatic improvement often occurs once the pleura is opened (Starkey, 1955). The condition may perhaps be becoming more common in elderly male patients (Clain and Heffernan, 1956), and age should not be a deterrent to operation in these cases, although the operative mortality is high.We wish to illustrate some of these points in presenting this small series of cases. These appear to be the only examples of the condition admitted to this hospital during the 7-year period 1950-6. Ruptures of the oesophagus due to trauma or associated with neoplasm, peptic ulcer or oesophagitis were of course excluded. Case No. IA man, aged 71, admitted 13th May, 195 6. SUdden onset of severe pain at the lower end of the sternum whilst swallowing a piece of teacake 2 days earlier. Pain made him double up and was associated with cough and sweating.