Presentation
Three-hour history of epigastric pain with one episode of vomiting after eating.
Patient Data
On-table oral contrast confirms esophageal rupture and leak, with a large, non contained collection of oral contrast in the posterior mediastinum and pneumomediastinum. Source of rupture defined in the distal esophagus, just above the level of the gastro-esophageal junction with the tear measuring 6 mm AP along the left posterolateral wall at approximately the 4 to 5 o'clock position.
Bilateral large pleural effusions with further contrast in the left pleural effusion due to communication with the posterior mediastinum effusion. Related bibasal collapse/consolidation.
Case Discussion
Spontaneous esophageal rupture accounts for 15% of all esophageal rupture cases. It is most commonly seen in the left, posterolateral aspect of the thoracic esophagus possibly due to anatomical weakening. Mediastinitis and a left pleural effusion can occur due to leakage of gastric contents 1.
This patient proceeded to endoscopy confirming a linear tear in the esophageal mucosa. Following this, a laparotomy was performed with the tear being closed surgically. A drain was also placed into the posterior mediastinum following extensive washout. Unfortunately, the patient passed away from complications associated with the rupture. The morbidity rate following esophageal rupture is around 15% 1.
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